| 梁志珲,张跃辉,张秋琪,邵将,宋佳*.单节段融合联合邻近节段动态稳定系统治疗双节段腰椎退行性疾病[J].脊柱外科杂志,2023,21(5):306-310,315. |
单节段融合联合邻近节段动态稳定系统治疗双节段腰椎退行性疾病  点此下载全文 (Fulltext) |
| 梁志珲 张跃辉 张秋琪 邵将 宋佳* |
| 上海交通大学医学院附属新华医院脊柱中心, 上海 200092 |
| 基金项目： |
| DOI：10.3969/j.issn.1672-2957.2023.05.004 |
| 摘要点击次数: 393 |
| 全文下载次数: 26 |
| 摘要： |
| 目的 探讨采用单节段融合联合邻近节段Coflex动态稳定系统（Topping-off手术）治疗双节段腰椎退行性变的临床疗效。方法 回顾性分析2015年1月—2016年12月收治的双节段腰椎退行性变（上位节段中度退行性变并中度椎管狭窄且无不稳定，下位节段严重退行性变）患者41例，采用Topping-off手术治疗19例（topping-off组），采用传统后路腰椎椎间融合术（PLIF）治疗22例（PLIF组）。记录2组手术时间、术中出血量；术前、术后1年及末次随访时采用疼痛视觉模拟量表（VAS）评分评估腰腿痛程度，Oswestry功能障碍指数（ODI）和日本骨科学会（JOA）评分评价腰椎功能；测量并记录术前、术后1年及末次随访时的腰椎手术节段活动度（ROM）。结果 所有手术顺利完成，所有患者随访> 48个月。Topping-off组手术时间及术中出血量少于PLIF组，差异均有统计学意义（P < 0.05）。2组术后1年及末次随访时腰腿痛VAS评分、ODI及JOA评分较术前显著改善，差异均有统计学意义（P < 0.05）；各时间点组间差异无统计学意义（P > 0.05）。Topping-off组术后1年及末次随访时腰椎手术节段ROM与术前相比，差异无统计学意义（P > 0.05）；PLIF组术后1年及末次随访时腰椎手术节段ROM较术前显著减小，且小于topping-off组，差异均有统计学意义（P < 0.05）。结论 采用Topping-off手术治疗腰椎退行性疾病安全、有效，术后患者症状得到有效缓解，长期随访临床疗效满意。相比双节段PLIF，Topping-off手术具有手术时间短，术中出血量少，可更好地保护术后患者腰椎屈伸活动功能的优势。 |
| 关键词：腰椎 椎间盘移位 椎管狭窄 假体和植入物 脊柱融合术 |
| Single-segment fusion combined with adjacent segment dynamic stabilization system for treatment of dual segment lumbar degenerative diseases Fulltext |
| Liang Zhihui Zhang Yuehui Zhang Qiuqi Shao Jiang Song Jia* |
| Department of Spinal Center, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China |
| Fund Project: |
| Abstract: |
| Objective To explore the clinical efficacy of single segment fusion combined with adjacent segment Coflex dynamic stabilization system（topping-off surgery） in the treatment of dual segment lumbar degenerative changes. Methods From January 2015 to December 2016，41 patients with dual level lumbar degeneration（upper level moderate degeneration with moderate spinal stenosis and no instability，lower level severe degeneration） were admitted. Among them，19 patients were treated with topping-off surgery（topping-off group），and 22 with traditional posterior lumbar interbody fusion（PLIF group）. The operation time and intraoperative blood loss were recorded. At pre-operation，postoperative 1 year and the final follow-up，visual analogue scale（VAS） score was used to assess the intensity of low back and leg pain，and Oswestry disability index（ODI） and Japanese Orthopaedic Association（JOA） score were used to assess the lumbar function. The range of motion（ROM） of operated segment at pre-operation，postoperative 1 year and the final follow-up were measured and recorded. Results All the operations were successfully completed，and all the patients were followed up for more than 48 months. The operation time and intraoperative blood loss in the topping-off group were lower than those in the PLIF group，and the differences were statistically significant（P < 0.05）. The VAS score of low back and leg pain，ODI and JOA scores in the 2 groups at postoperative 1 year and the final follow-up were significantly improved compared with those at pre-operation，and the differences were statistically significant（P < 0.05）；and there was no statistically significant difference between the 2 groups at each time point（P > 0.05）. In the topping-off group，there was no statistically significant difference in the ROM of the operated segment at postoperative 1 year and the final follow-up compared to the pre-operation（P > 0.05）；in the PLIF group，the ROM of the operated segment was significantly reduced at postoperative 1 year and the final follow-up compared to the pre-operation，with a statistically significant difference（P < 0.05）；there were statistically significant differences between the 2 groups at postoperative 1 year and the final follow-up（P < 0.05）. Conclusions The topping-off surgery for lumbar degenerative diseases is safe and effective，and postoperative symptoms have been effectively relieved. The long-term clinical efficacy is satisfactory. Compared to dual-segment PLIF，topping-off surgery has the advantages of shorter operation time，less intraoperative blood loss，and better protection of postoperative lumbar flexion and extension function. |
| Keywords:Lumbar vertebrae Intervertebral disc displacement Spinal stenosis Intervertebral disc displacement Spinal fusion |
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