椎间髓核摘除辅以Isobar后路动态固定治疗腰椎间盘突出症的临床分析

Evaluation of discectomy combined with Isobar dynamic stabilization for lumbar disc protrusion

目的评估髓核摘除辅以Isobar动态固定治疗腰椎间盘突出症的临床疗效。方法 2009年5月至2010年11月行髓核摘除辅以Isobar动态固定治疗并获得24个月以上随访资料的患者21例。采用疼痛视觉模拟评分(visual ana-logue scale,VAS)、功能障碍指数(oswestry disability index,ODI)评定临床疗效。腰椎正侧过伸过屈位片测量动态固定节段及头侧邻近节段椎间隙高度比值(intervertebral space ratio,IVS)、椎间活动度(range of motion,ROM)和腰椎总活动度(L1～L5)的变化,采用Woodend分级评价椎间盘髓核有无信号改变。随访时间(28.45±3.59)个月。结果术后24个月VAS和ODI评分较术前均显著改善(P<0.05)。动态固定节段及邻近节段椎间隙高度比均较术前降低(P<0.05)。屈伸活动度:动态固定节段由(5.62±4.30)°降至(3.53±1.52)°(P<0.01),邻近节段和腰椎总活动度较术前均增加(P<0.05)。动态固定节段及邻近节段髓核信号与术前相比无明显改变(P>0.05)。结论髓核摘除辅以Isobar动态固定治疗腰椎间盘突出症具有满意的近期临床疗效,能维持固定节段术后椎间隙高度并保留一定的运动度,是一种可取的治疗方法。

Objective To evaluate the clinical outcomes and effects on lumbar disc protrusion by discectomy combined with Isobar dynamic stabilization. Methods The clinical data of twenty-one patients with lumbar disc protrusion underwent discectomy combined with Isobar dynamic stabilization was retrospectively analyzed. Clinical outcomes were evaluated using Oswestry disability index （ODI） and visual analogue scale （VAS）. Radiological evaluations included whole spine AP/lateral, lumbar neutral, flexion, and extension X-ray. The follow-up period was 28.45±3.59 months. Results The ODI and VAS were significantly improved at 24 month after operation （P〈0.05）. Intervertebral disc ratio slightly decreased as compared with preoperative stabilized and above segments （P〈0.05）. For range of motion （ROM） of the lumbar spine： stabilized segments significantly decreased from 5.62±4.30 degrees to 3.53±1.52 degrees, while the ROM of above segments and total lumbar spine （L1-L5） increased （P〈0.05）. The Wooden classification was not changed in final follow-up in stabilized and above segments （P〉0.05）. Conclusion Discectomy combined with Isobar dynamic stabilization for lumbar disc protrusion presents satisfactory short-term results. It maintains the fixed intervertebral spaces, and preserves part of ROM, suggesting it is a possible treatment approach.