ISOBAR TTL动态固定治疗多节段腰椎退行性病变的早期疗效

Early clinical effect of ISOBAR TTL dynamic fixation for the treatment of multi-level lumbar degeneration

目的评价ISOBAR TTL动态固定治疗多节段腰椎退行性病变的早期临床效果。方法选取2015年7月至2016年7月广州中医药大学附属顺德医院收治的60例多节段腰椎退行性病变患者作为研究对象,随机分为2组,治疗组采用ISOBAR TTL动态固定,对照组采用融合固定。所有患者均随访1年,观察两组手术时间、术中出血量等一般手术指标,记录术后6个月及1年随访时邻近节段退变UCLA分级和相关并发症发生情况,比较两组视觉模拟量表(VAS)评分及日本骨科学会(JOA)评分的差异。结果两组手术时间、术中出血量、术中X线暴露次数及术后引流量比较,差异无统计学意义(P>0.05)。术后1 d、6个月、1年随访时两组VAS评分和JOA评分均较术前明显改善(P<0.05),但术后各时相点组间比较,差异无统计学意义(P>0.05)。术后6个月、1年随访时治疗组动态固定节段与相邻节段椎间盘退变UCLA分级相似(P>0.05),其中相邻节段椎间盘退变UCLA分级1年随访时优于对照组(P<0.05)。治疗组5枚螺钉发生松动,螺钉松动率明显低于对照组(2.5%vs 8.7%,P<0.05);两组均未出现内固定断裂、切口感染并发症。结论 ISOBAR TTL动态内固定与融合固定手术治疗多节段腰椎退行性疾病均可获得满意的短期疗效;与融合固定相比,ISOBAR TTL动态内固定对术后腰椎节段影响小,可显著降低早期相邻节段退变的发生率。

Objective To evaluate the early clinical effects of ISOBAR TTL dynamic fixation for the treatment of multi-level lumbar degeneration.Methods Sixty patients with multi-level lumbar degenerative diseases treated from July 2015 to July 2016 in Shunde Hospital Affiliated to Guangzhou University of Chinese Medicine were selected and randomly divided into 2 groups:treatment group with ISOBAR TTL dynamic fixation and control group with fusion fixation.Each group was followed up for 1 year.General operation indicators such as operative time,intraoperative estimate blood loss in two groups were observed,UCLA grading of adjacent segment degeneration and related complications were recorded at 6 months and 1 year follow up after the surgery,at the same time,differences of visual analogue scale(VAS)and Japanese Orthopaedic Association(JOA)scores were compared between two groups.Results Comparing the operation time,intraoperative estimate blood loss,intraoperative X-ray exposure times and postoperative drainage volume,there were no statistical differences between two groups(P>0.05).At 1 d,6 months and 1 year follow up postoperatively,VAS and JOA scores were significantly improved compared with preoperative ones(P<0.05);While compared with the above indicators at the different timepoints after the surgery,the difference had no statistical significance between two groups(P>0.05).At 6 months and 1 year follow up postoperatively,UCLA grading of intervertebral disc degeneration(IDD)in adjacent segment was similar to the dynamic fixed segment in treatment group(P>0.05);In control group,UCLA grading of IDD in adjacent segment at 1 year follow up postoperatively was inferior to that in treatment group(P<0.05).Five screws loosening were found in treatment group,the incidence was lower than that in control group significantly(2.5%vs 8.7%,P<0.05);No complications of internal fixation breakage or surgical site infection had happened in each group.Conclusions For the treatment of lumbar degenerative diseases,both ISOBAR TTL dynamic internal fixation and fusion fixation could achieve satisfactory short-term results;Compared with fusion fixation,dynamic fixation with ISOBAR TTL has less influence on postoperative lumbar spine,so as to reduce the incidence of IDD in adjacent segments significantly in the short term.