动力内固定系统预防腰椎融合内固定术后邻近节段退变

Lumbar dynamic device for preventing adjacent segment degeneration after rigid lumbar fixation

目的观察在头侧邻近节段加载动力内固定是否有助于降低刚性内固定术后邻近节段的退变。方法筛选2002年1月－2007年7月因腰腿痛（腰椎椎间盘突出症、腰椎椎管狭窄症及腰椎滑脱症）由同一组医师完成腰椎内固定手术的101名患者。分为A组和B组,A组为单纯刚性内固定（72名）,B组为在刚性内固定的头侧邻近节段加载动力内固定（29名）。比较2种手术术后邻近节度退变的发生率、Oswestry功能障碍指数（Oswestry disability index,ODI）及视觉模拟量表（visual analog scale,VAS）评分。结果 A组中有15例患者（20.83%）发生了邻近节段退变,B组中有1例（3.45%）发生了邻近节段退变,两者之间差异有统计学意义（P〈0.05）。只有最佳恢复期内B组比A组得到了更好的ODI及VAS评分结果且差异有统计学意义（P〈0.05）;至末次随访期时2组的ODI及VAS评分之间差异并无统计学意义（P〉0.05）。结论在刚性内固定的头侧邻近节段加载动力内固定确实能有效地预防邻近节段退变的发生,但是其并不能显著地提高远期临床效果。

Objective To identify whether lumbar dynamic device adding to the cephalic adjacent segment can prevent adjacent segment degeneration（ASD） after rigid lumbar fixation or not.Methods From January 2002 to July 2007,101 patients who suffered from lumbago-leg pain because of lumbar disc herniation,lumbar spinal stenosis and lumbar spodylolisthesis received the lumbar internal fixation treatment by the same operator.Patients simply receiving rigid lumbar fixation were classified to Group A（72 cases）,meanwhile,patients who received the lumbar dynamic fixation were classified to Group B（29 cases）.Incidence rate of ASD,Oswestry disability index（ODI） and visual analog scale（VAS） score were compared between the 2 groups.Results There were 15 patients who suffered from ASD in Group A,meanwhile,only 1 patient in Group B.The difference between the 2 groups was statistically significant（P0.05）.ODI and VAS score of Group B were better than Group A in the optimal recovery period,and the difference between the 2 groups was statistically significant.But there was no difference between the 2 groups at the final follow-up（P0.05）.Conclusion The lumbar dynamic device adding to the cephalic adjacent segment can protect the adjacent segment from ASD.But it can not elevate the operative effect in the long term.