动态内固定对单节段腰椎间盘突出症椎间融合的影响

Effect of dynamic fixation on lumbar fusion rate in patients with single level lumbar disc herniation

目的:比较分析经椎体间融合术合并动态及刚性两种不同内固定方式治疗单节段腰椎间盘突出症(LDH)术后疗效及椎间融合程度的差异.方法:回顾分析51例行后路单节段椎间融合的患者,其中动态组(A组)17例和刚性组(B组) 34例,比较两组患者的手术时间、出血量,术前和术后的影像学资料,术后椎间融合程度,以及术前、术后腰部及腿部视觉模拟评分(VAS)、功能障碍评分(ODI)、日本骨科协会评估治疗评分(JOA)等,评估两组的手术疗效,分析比较两种内固定方式术后椎间融合情况及邻近节段退变的差异.结果:51例患者均获得随访,在术后3个月及末次检查发现,腰部及腿部VAS评分、ODI及JOA评分、术椎椎间隙高度差异,两组比较无统计学差异(P> 0. 05).术后3个月,A组术椎ROM明显高于B组(P <0. 05),而术后末次检查两组术椎椎间活动范围(ROM)(P> 0. 05)无统计学差异.术后3个月及末次,两组上邻椎椎间隙高度无统计学差异.在术后3个月,两组上邻椎体ROM没有统计学差异(P> 0. 05),而末次检查A组的上邻椎体ROM低于B组(P <0. 05).术后3个月、6个月A组的融合程度评分明显高于B组,而术后末次,两组的融合程度评分(P> 0. 05)则无统计学差异.结论:动态内固定较刚性内固定有利于节段早期融合及延缓上邻节段退变.

Objective: To study the differences of lumbar interbody fusion with different spinal internal fixation system (dynamic and rigid) in the outcomes and the fusion rate for the treatment of single level lumbar disc herniation (LDH). Methods: A retrospective analysis was made for the clinical data of 51 patients with single level lumbar disc herniation who received posterior spinal fusion with pedicle screws and rods. The patients were divided into two groups. Seventeen cases in group A treated with dynamic fixation system and 34 cases in group B treated with rigid fixation system. Comparisons were made between the basic information (duration of surgery, blood loss) and image data (operative disc height and ROM, adjacent segment height and ROM, fusion score) of both groups as well as preoperative and postoperative VAS, ODI, JOA questionnaires of waist and leg to evaluate the surgical effect. The different effect of the two fixation systems in postoperative interbody fusion and adjacent segment degeneration was discussed. Results: The radiological data obtained at 3 months post-operation and the last examination in follow-up showed that VAS, ODI, JOA, operative disc height and adjacent segment height was not statistically significant (P>0.05) between group A and B. The operative disc ROM of group A was higher than that of group B at 3 months post-operation, but the final radiological index difference of operative disc ROM was not statistically significant (P>0.05). The adjacent segment ROM radiological index difference was not statistically significant (P>0.05) at 3 months post-operation, but the final adjacent segment ROM of group A was lower than that of group B ( P<0.05). The fusion rate score of group A was markedly higher than that of group B at 3 and 6 months post-operation, but it was not statistically significant (P>0.05) at final follow-up. Conclusion: Dynamic internal fixation system is more conducive than rigid fixation system to early fusion of fusion segments and to delay the degeneration of adjacent segments.