摘要
目的 ：评估K-Rod脊柱动态稳定系统治疗多节段腰椎退行性疾病的临床疗效。方法 ：2011年10月至2013年10月应用K-Rod脊柱动态稳定系统治疗多节段腰椎退行性疾病20例,男8例,女12例;年龄31-65岁,平均45.4岁;病程9个月-6.25年,平均3.8年。所有患者术前有腰腿痛病史,其中极外侧腰椎间盘突出症10例,腰椎管狭窄症7例,腰椎滑脱3例（Ⅰ度滑脱2例,Ⅱ度滑脱1例）,所有病例的责任节段为单节段,并且责任间隙的相邻椎间盘至少有1节已经出现明显退变。进行手术解除神经压迫及植入K-Rod脊柱后路动态稳定系统（其中责任间隙行椎间融合,退变邻椎行动态稳定）。采用疼痛视觉模拟评分（VAS）、日本矫形外科协会关于下腰痛的评分标准（JOA）和Oswestry功能障碍指数（ODI）评估临床疗效;通过影像学资料对退变邻椎节段活动度（ROM）、椎间盘高度及椎间盘信号（根据改良Pfirrmann分级系统）进行评估。结果：全部患者获得1年以上随访,术前症状均明显缓解,腰腿痛VAS、JOA及ODI术前与术后1周、术后1年差异均有统计学意义（P〈0.05）。术后影像学检查见责任节段均已融合,未见内植物松动、移位及断裂。术后相邻椎间盘的ROM有所减少（P〈0.05）。相邻退变椎间盘的高度术后1年与术前比较差异无统计学意义（P〉0.05）。对25个相邻椎间盘应用改良Pfirrmann分级系统进行分级并对比,术后1年共有8个（32%）椎间盘在评级中有所好转,15个（60%）椎间盘在评级中无变化,2个（8%）椎间盘在评级中退变加重。结论：应用腰椎融合辅以邻近节段动态固定的K-Rod脊柱动态稳定系统治疗多节段腰椎退行性疾病,可以取得良好的近期临床疗效。
Objective：To evaluate the clinical effects of dynamic neutralization system（K-Rod） in treating multisegmental lumbar degenerative disease. Methods：From October 2011 to October 2013,20 patients with multisegmental lumbar degenerative disease were treated with dynamic neutralization system（K-Rod）. There were 8 males and 12 females with an average age of 45.4 years old（ranged from 31 to 65） and an average course of 3.8 years（ranged from 9 months to 6.25 years）. All patients had the history of low back and legs pain. Among them,10 cases were far lateral lumbar disc herniation,7 cases were lumbar spinal stenosis,3 cases were lumbar spondylolisthesis（degree Ⅰin 2 cases and degree Ⅱ in 1 case）. Every patient had only one responsible segment which causing the symptom would have to be rigidly fixed during operations,and the adjacent intervertebral disc of the responsible segments at least 1 segment has already obvious degenerated. All patients underwent the operation to relieve compressed nerves and reconstruct spinal stability with K-Rod system（the responsible segments were fixed with interbody fusion,and the adjacent segments were fixed with dynamic stabilization）. Visual analogue scale（VAS）,Japanese Orthopaedic Association Scores（JOA） and Oswestry Disability Index（ODI） were used to evaluate the clinical effects. Imaging data were used to analyze the range of motion（ROM）,intervertebral disc height and intervertebral disc signal（according to modified Pfirrmann grading system） in degenerative adjacent segment. Results：All patients were followed up for more than 1 year,and preoperative symptoms obviously relieved. There were significant differences in VAS,JOA,ODI between preoperative and postoperative（postoperative at 1 week and 1 year）（P〈0.05）. Radiological examination showed that all responsible segments had already fused,and no looseness,displacement and breakage of internal fixations were found. Postoperative at 1 year,the ROM of adjacent segments were decreased（P〈0.05）. There was no significant difference in intervertebral disc height between preoperative and postoperative at 1 year（P〉0.05）. According to modified Pfirrmann grading system to classification for the 25 disks of adjacent segment,8 disks（32%） got improvement,15 disks（60%） got no change and 2 disks（8%）got aggravation at 1 year after operation. Conclusion：Dynamic neutralization system（K-Rod） combined with interbody fusion could obtain short term clinical effects in the treatment of multisegmental lumbar degenerative disease.
出处
《中国骨伤》
CAS
2015年第11期988-993,共6页
China Journal of Orthopaedics and Traumatology
基金
宁波市自然科学基金项目(编号:2015A610306)~~
作者简介
通讯作者：蒋国强E—mail：jgq6424@hotmail．com
