微动棒非融合手术治疗单节段腰椎管狭窄的短期疗效观察
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摘要
背景:腰椎管减压融合手术治疗腰椎管狭窄的临床效果是得到广泛认可的,然而这种手术存在手术时间长、损伤大的不足。近年,微动棒非融合技术逐渐进入临床,我们尝试将其应用于腰椎管狭窄患者的治疗。目的:比较腰椎微动棒非融合术和传统融合术治疗单节段腰椎管狭窄症的临床疗效。方法:回顾性分析2016年1月至2016年12月45例单节段腰椎管狭窄症患者的临床资料。26例行传统腰椎管减压椎间融合术,19例采用微动棒非融合术。比较两种术式的手术时间、出血量、术后引流量和术后住院时间,记录两组患者术前,术后3、6个月的视觉疼痛模拟(VAS)评分、Oswestry功能障碍指数(ODI)、日本骨科学会(JOA)评分。术后6个月随访时的腰椎功能采用改良MacNab评价标准进行评价。结果:两组患者均顺利完成手术及随访。平均随访6个月。与腰椎融合组相比,微动棒组手术时间较短,出血量和术后引流量较少,差异有统计学意义(P<0.05),但两组的术后住院时间比较无显著统计学差异(P>0.05)。两组术后3、6个月VAS评分、ODI值和JOA评分较术前均明显改善(P<0.05);但两组间术后VAS评分和ODl分值的差异,以及JOA评分改善率均无统计学意义(P>0.05)。按照改良MacNab标准评定优良率,末次随访时微动棒组和融合组分别为82.7%和83.5%,两组间比较无统计学差异(P>0.05)。结论:腰椎微动棒非融合技术和传统融合技术均能有效治疗中老年单节段腰椎管狭窄症;微动棒具有手术创伤小、手术时间短、出血少等优势,短期疗效满意。
Background: Lumbar interbody fusion has a good clinical effect for lumbar spinal stenosis. However,long operation time and big trauma are the shortage of the operation. Recently, dynamic stabilization system is gradually used in clinical work, we try to apply the dynamic stabilization system to treat single segment lumbar spinal stenosis. Objective: To compare the preliminary clinical outcomes of dynamic stabilization system(the Isobar system) and lumbar interbody fusion for lumbar spinal stenosis. Methods: A total of 45 patients with single segment lumbar spinal stenosis treated surgically from January2016 to December 2016 were enrolled in this retrospective study. Of them, 26 underwent traditional interbody fusion(control group) and 19 received decompression and dynamic stabilization with Isobar system(experimental group). Operative time, intraoperative blood loss, postoperative drainage volume and postoperative hospital stay were compared between two groups. Visual analogue scale(VAS) score, Oswestry disability index(ODI) and Japanese Orthopedic Association(JOA) score were used to assess clinical outcome preoperatively and 3 and 6 months postoperatively. The modified MacNab criteria were used to measure the clinical outcomes at 6 months after surgery. Results: All the patients successfully completed the surgery and shortterm follow-up. The mean duration of follow-up was 6 months. Compared with the control group, the experimental group achieved shorter operative time, less intraoperative blood loss and postoperative drainage volume(P<0.05), but there was no significant difference in the postoperative hospital stay between the 2 groups(P>0.05). Postoperative VAS scores, ODI and JOA scores at each follow-up time point in both groups were significantly improved as compared with preoperative ones(P<0.05). But there was no significant difference between groups in the JOA score improvement rate(P>0.05). According to the modified MacNab criteria, the excellent and good rate was 82.7% and 83.5% at 6 months after surgery in the experimental group and control group, respectively, but no significant difference was found between them(P>0.05). Conclusions: Both dynamic stabilization system and lumbar interbody fusion can effectively treat single segment lumbar spinal stenosis. However,dynamic stabilization system has many advantages such as less trauma, less blood loss, shorter operation time and satisfactory short-term outcomes.
Background: Lumbar interbody fusion has a good clinical effect for lumbar spinal stenosis. However,long operation time and big trauma are the shortage of the operation. Recently, dynamic stabilization system is gradually used in clinical work, we try to apply the dynamic stabilization system to treat single segment lumbar spinal stenosis. Objective: To compare the preliminary clinical outcomes of dynamic stabilization system(the Isobar system) and lumbar interbody fusion for lumbar spinal stenosis. Methods: A total of 45 patients with single segment lumbar spinal stenosis treated surgically from January2016 to December 2016 were enrolled in this retrospective study. Of them, 26 underwent traditional interbody fusion(control group) and 19 received decompression and dynamic stabilization with Isobar system(experimental group). Operative time, intraoperative blood loss, postoperative drainage volume and postoperative hospital stay were compared between two groups. Visual analogue scale(VAS) score, Oswestry disability index(ODI) and Japanese Orthopedic Association(JOA) score were used to assess clinical outcome preoperatively and 3 and 6 months postoperatively. The modified MacNab criteria were used to measure the clinical outcomes at 6 months after surgery. Results: All the patients successfully completed the surgery and shortterm follow-up. The mean duration of follow-up was 6 months. Compared with the control group, the experimental group achieved shorter operative time, less intraoperative blood loss and postoperative drainage volume(P<0.05), but there was no significant difference in the postoperative hospital stay between the 2 groups(P>0.05). Postoperative VAS scores, ODI and JOA scores at each follow-up time point in both groups were significantly improved as compared with preoperative ones(P<0.05). But there was no significant difference between groups in the JOA score improvement rate(P>0.05). According to the modified MacNab criteria, the excellent and good rate was 82.7% and 83.5% at 6 months after surgery in the experimental group and control group, respectively, but no significant difference was found between them(P>0.05). Conclusions: Both dynamic stabilization system and lumbar interbody fusion can effectively treat single segment lumbar spinal stenosis. However,dynamic stabilization system has many advantages such as less trauma, less blood loss, shorter operation time and satisfactory short-term outcomes.
引文
[1]张力,舒小秋,段扬,等.ISOBAR TTL半坚强后路动态内固定系统治疗腰椎退行性疾病疗效观察.中国修复重建外科杂志,2012, 26(9):1066-1070.
[2] Hu Y, Gu Y, Xu R, et al. Short-term clinical observation of the Dynesys neutralization system for the treatment of degenerative disease of the lumbar vertebrae. Orthop Surg, 2011, 3(3):167-175.
[3] Kraiwattanapong C, Wechmongkolgorn S, Chatriyanuyok B,et al. Outcomes of fluoroscopically guided lumbar transforaminal epidural steroid injections in degenerative lumbar spondylolisthesis patients. Asian Spine J, 2014, 8(2):119-128.
[4]马辉,李忠海,朱晓东,等.腰椎椎间融合术与动态固定术治疗腰椎退行性疾病的临床评价.脊柱外科杂志,2011,9(4):226-231.
[5] Li Z, Li F, Yu S, et al. Two-year follow-up results of the Isobar TTL Semi-Rigid Rod System for the treatment of lumbar degenerative disease. J Clin Neurosci, 2013, 20(3):394-399.
[6] Qian J, Bao ZH, Li X, et al. Short-term therapeutic efficacy of the isobar TTL dynamic internal fixation system for the treatment of lumbar degenerative disc diseases. Pain Physician, 2016, 19(6):E853-E861.
[7]李岳,关振松.后路椎间盘手术系统治疗腰椎管狭窄症的临床疗效.临床医学研究与实践,2017, 2(18):74-75.
[8]陈勇.腰椎间盘突出症术后复发16例的原因分析及治疗.广西医学,2012, 34(11):1586-1589.
[9] Hsu W, Lui T, Chang C, et al. Minimally invasive decompression with posterior column reinforcement for the treatment of symptomatic osteoporotic fracture with spinal stenosis in lumbar vertebrae. J Clin Neurosci, 2011, 18(12):1645-1650.
[10] Pradhan B, Turner A, Zatushevsky M. Biomechanical analysis in a human cadaveric model of spinous process fixation with an interlaminar allograft spacer for lumbar spinal stenosis:Laboratory investigation. J Neurosurg Spine, 2012, 16(6):585-593.
[11] Schmier JK, Halevi M, Maislin G, et al. Comparative cost effectiveness of Coflex(?)interlaminar stabilization versus instrumented posterolateral lumbar fusion for the treatment of lumbar spinal stenosis and spondylolisthesis. Clinicoecon Outcomes Res, 2014, 18(6):125-131.
[12] Daisuke H, Nodoka M, Masatake I. The association of each disability based on the three sub-categories of the RolandMorris disability questionnaire during hospitalization with itself at 1 year postoperatively in patients with degenerative lumbar spinal stenosis. Asian Spine J, 2014, 8(1):1-7.
[13]蒋毅,宋华伟,王东,等. JOABPEQ对非融合手术治疗腰椎管狭窄症的临床疗效评价.北京医学,2013, 35(10):815-817.
[14] Kumar N, Shah S, Ng Y, et al. Role of coflex as an adjunct to decompression for symptomatic lumbar spinal stenosis.Asian Spine J, 2014, 8(2):161-169.
[15] Heo D, Cho Y, Cho S, et al. Adjacent segment degeneration after lumbar dynamic stabilization using pedicle screws and a nitinol spring rod system with 2-year minimum follow-up.J Spinal Disord Tech, 2012, 25(2):409-414.
[16]刘明立,李放.腰椎融合联合非融合技术预防邻近节段退变的应用分析.中华临床医师杂志(电子版),2016, 10(18):2762-2765.
[17]陈小龙,海涌,关立,等. Topping-off手术治疗腰椎退行性疾病的影像学分析.中国脊柱脊髓杂志,2015, 25(1):6-12.
[18] Erbulut D, Zafarparandeh I, Hassan C, et al. Determination of the biomechanical effect of an interspinous process device on implanted and adjacent lumbar spinal segments using a hybrid testing protocol:a finite-element study. J Neurosurg,2015, 23(1):200-208.
[19]惠正广,张镇,刘诗荣,等.责任节段减压固定融合治疗老年人多节段退行性腰椎管狭窄的效果分析.中华骨与关节外科杂志,2015, 8(6):486-490.
[20] Lee SE, Jahng TA, Kim HJ. Decompression and nonfusion dynamic stabilization for spinal stenosis with degenerative lumbar scoliosis:Clinical article. J Neurosurg Spine, 2014, 21(4):585-594.
[21] Yu SW, Yang SC, Ma CH, et al. Comparison of Dynesys posterior stabilization and posterior lumbar interbody fusion for spinal stenosis L4L5. Acta Orthop Belg, 2012, 78(2):230-239.
[2] Hu Y, Gu Y, Xu R, et al. Short-term clinical observation of the Dynesys neutralization system for the treatment of degenerative disease of the lumbar vertebrae. Orthop Surg, 2011, 3(3):167-175.
[3] Kraiwattanapong C, Wechmongkolgorn S, Chatriyanuyok B,et al. Outcomes of fluoroscopically guided lumbar transforaminal epidural steroid injections in degenerative lumbar spondylolisthesis patients. Asian Spine J, 2014, 8(2):119-128.
[4]马辉,李忠海,朱晓东,等.腰椎椎间融合术与动态固定术治疗腰椎退行性疾病的临床评价.脊柱外科杂志,2011,9(4):226-231.
[5] Li Z, Li F, Yu S, et al. Two-year follow-up results of the Isobar TTL Semi-Rigid Rod System for the treatment of lumbar degenerative disease. J Clin Neurosci, 2013, 20(3):394-399.
[6] Qian J, Bao ZH, Li X, et al. Short-term therapeutic efficacy of the isobar TTL dynamic internal fixation system for the treatment of lumbar degenerative disc diseases. Pain Physician, 2016, 19(6):E853-E861.
[7]李岳,关振松.后路椎间盘手术系统治疗腰椎管狭窄症的临床疗效.临床医学研究与实践,2017, 2(18):74-75.
[8]陈勇.腰椎间盘突出症术后复发16例的原因分析及治疗.广西医学,2012, 34(11):1586-1589.
[9] Hsu W, Lui T, Chang C, et al. Minimally invasive decompression with posterior column reinforcement for the treatment of symptomatic osteoporotic fracture with spinal stenosis in lumbar vertebrae. J Clin Neurosci, 2011, 18(12):1645-1650.
[10] Pradhan B, Turner A, Zatushevsky M. Biomechanical analysis in a human cadaveric model of spinous process fixation with an interlaminar allograft spacer for lumbar spinal stenosis:Laboratory investigation. J Neurosurg Spine, 2012, 16(6):585-593.
[11] Schmier JK, Halevi M, Maislin G, et al. Comparative cost effectiveness of Coflex(?)interlaminar stabilization versus instrumented posterolateral lumbar fusion for the treatment of lumbar spinal stenosis and spondylolisthesis. Clinicoecon Outcomes Res, 2014, 18(6):125-131.
[12] Daisuke H, Nodoka M, Masatake I. The association of each disability based on the three sub-categories of the RolandMorris disability questionnaire during hospitalization with itself at 1 year postoperatively in patients with degenerative lumbar spinal stenosis. Asian Spine J, 2014, 8(1):1-7.
[13]蒋毅,宋华伟,王东,等. JOABPEQ对非融合手术治疗腰椎管狭窄症的临床疗效评价.北京医学,2013, 35(10):815-817.
[14] Kumar N, Shah S, Ng Y, et al. Role of coflex as an adjunct to decompression for symptomatic lumbar spinal stenosis.Asian Spine J, 2014, 8(2):161-169.
[15] Heo D, Cho Y, Cho S, et al. Adjacent segment degeneration after lumbar dynamic stabilization using pedicle screws and a nitinol spring rod system with 2-year minimum follow-up.J Spinal Disord Tech, 2012, 25(2):409-414.
[16]刘明立,李放.腰椎融合联合非融合技术预防邻近节段退变的应用分析.中华临床医师杂志(电子版),2016, 10(18):2762-2765.
[17]陈小龙,海涌,关立,等. Topping-off手术治疗腰椎退行性疾病的影像学分析.中国脊柱脊髓杂志,2015, 25(1):6-12.
[18] Erbulut D, Zafarparandeh I, Hassan C, et al. Determination of the biomechanical effect of an interspinous process device on implanted and adjacent lumbar spinal segments using a hybrid testing protocol:a finite-element study. J Neurosurg,2015, 23(1):200-208.
[19]惠正广,张镇,刘诗荣,等.责任节段减压固定融合治疗老年人多节段退行性腰椎管狭窄的效果分析.中华骨与关节外科杂志,2015, 8(6):486-490.
[20] Lee SE, Jahng TA, Kim HJ. Decompression and nonfusion dynamic stabilization for spinal stenosis with degenerative lumbar scoliosis:Clinical article. J Neurosurg Spine, 2014, 21(4):585-594.
[21] Yu SW, Yang SC, Ma CH, et al. Comparison of Dynesys posterior stabilization and posterior lumbar interbody fusion for spinal stenosis L4L5. Acta Orthop Belg, 2012, 78(2):230-239.