可滑动椎弓根钉棒系统的设计和在腰椎融合中的疗效

Design of a slideable pedicle screw-rod system and its efficacy in the treatment of lumbar spine fusion

目的探讨一种新型可滑动椎弓根钉棒系统设计的可行性，以及分析其应用于治疗腰椎退行性疾病的安全性及疗效。方法收集2014年6月至2016年6月采用新型可滑动钉棒系统行腰椎融合术的71例腰椎退行性疾病患者的资料，其中男47例，女24例，年龄30-73岁，平均57．6岁。分为椎间自体骨融合组（自体骨组）和椎间融合器融合组（融合器组），所有患者病变均为单节段。采用日本骨科学会（Japanese Orthopaedic Association，JOA）腰椎评分法及疼痛视觉模拟（visual analogue scale，VAS）评分标准进行疗效评价，通过腰椎正侧位X线片及CT扫描观察融合情况和融合节段高度变化情况，并记录手术时间及围手术期并发症情况。结果71例均顺利完成手术，其中自体骨组手术时间平均为（98．5±26．72）min，融合器组手术时间平均为（110．4±23．41）min；所有患者均获得随访，时间3-18个月，5例随访时间〉12个月；所有患者术后不同随访期椎间高度随着时间推移均出现不同程度降低，但无一例出现神经损害表现。自体骨组术后3个月腰痛及下肢痛VAS评分较术前平均降低4．7和6．8分，融合器组平均降低5．1和6．3分。两组患者术后3个月JOA评分较术前平均增加20．8和19．9分，差异有统计学意义。疗效评定：优45例，良20例，可6例，优良率为91．5％（65／71）。所有随访超过12个月的患者中有1例不能确定是否完全融合。结论该新型可滑动钉棒系统安全可行，临床疗效良好，可有效促进减压节段融合，可用于治疗腰椎退行性疾病。

Objective To investigate the efficacy and safety of a novel slideable pedicle screw-rod system in the treatment of lumbar degenerative diseases. Methods Analysed 71 patients （47 males and 24 females） with lumbar degenerative diseases underwent lumbar fusion using the novel slideable pedicle screw-rod system from June 2014 to June 2016, aged 30-73 years by average 57.6 years. All patients were divided into 2 groups according to different operative methods： autogenous bone group （34 patients, fusion with autogenous bone plus slideable pedicle screw-rod） and cage group （37 cases, fusion with cage and autogenous bone plus slideable pedicle screw-rod）. The Japanese Orthopaedic Association score （JOA） and visual analogue scale （VAS） were used to assess the clinical effect postoperatively while X-ray and CT were used to evaluate the fusion situation and the height variation of fusion segment. Results The average operation time was （98.5±26.72） rain in autogenous bone group, （110.4±23.41） min in cage group. All patients were followed up for 3-18 months and 5 cases were followed for more than 12 months. The height of fusion segment decreased postoperatively, however, there was no neurologic symptoms. The VAS score of low back pain and leg pain decreased by 4.7 and 6.8 points in autogenous bone group after 3 months postoperatively, it decreased by 5.1 and 6.3 points in cage group. JOA scores of 2 groups after 3 months after operation were increased by 20.8 and 19.9 points compared with preoperative scores. According to the criteria, the excellent and good rate was 91.5%. 1 case out of 5 cases followed more than 12 months can not be determined whether fusion was complete. Conclusion The novel slideable pedicle screw-rod system can provide a sat-isfactory outcome for the treatment of lumbar degenerative diseases and can promote the decompression segment fusion effectively.