动态固定椎弓根螺钉在腰椎退行性疾病Topping-off手术中应用的早期临床疗效

Early clinical observation of dynamic fixed pedicle screw in Topping-off procedure for lumbar degenerative diseases

目的:评价动态固定椎弓根螺钉在腰椎退行性疾病Topping-off手术中应用的早期临床疗效。方法:2018年1月~2019年12月间在我院脊柱外科对43例因腰椎退行性疾病需要进行腰椎融合手术且相邻节段已出现影像学改变的患者通过动态固定椎弓根螺钉进行Topping-off手术,其中男性25例,女18例,平均年龄61±6岁(52~76岁);双节段手术32例,三节段手术11例;L2/3动态固定8例,L3/4动态固定19例,L4/5动态固定16例;头端动态固定39例,尾端动态固定4例。回顾性分析患者术前、术后的腰/腿痛疼痛视觉模拟评分(VAS)以及改良Oswestry功能障碍指数(ODI)以及动态固定节段与其相邻节段椎间盘改良Pfirrmann分级、椎间盘高度(DSH)和关节活动范围(ROM)等。结果:全组病例均顺利完成手术,术后随访时间均为12个月,均未出现神经损伤及内置物相关并发症;平均手术时间107±16min(90~150min),平均术中出血量平均280±72ml(200~450ml),平均住院时间9±2d(7~12d);腰/腿痛VAS和ODI术后、术后3个月及术后1年均较术前明显改善(P<0.05);动态固定节段及其相邻节段椎间盘Pfirrmann分级在术前以及术后1年时均无明显差异(P>0.05),但在术前动态固定节段椎间盘Pfirrmann分级低于或等于Ⅴ级时术前与术后1年椎间盘退变情况有差异(P<0.05);动态固定节段及其相邻节段ROM、DSH在术前、术后3个月以及术后1年时均无明显差异(P>0.05)。结论:动态固定椎弓根螺钉在腰椎退行性疾病Topping-off手术中具有良好的早期临床疗效,能够保留腰椎融合术相邻节段一定的活动度,有效维持术后椎间隙高度以及椎间盘状态。

Objectives:To evaluate the early clinical efficacy of dynamic fixed pedicle screw in the treatment of lumbar degenerative disease with Topping-off procedure.Methods:From January 2018 to December 2019,43 patients with lumbar degenerative diseases who needed lumbar fusion surgery and whose adjacent segments had degeneration underwent Topping-off procedure by dynamic pedicle screw fixation.There were 25 males and 15 females with an average age of 61±6 years(range,52-76 years);32 cases underwent double segment operation and 11 cases underwent three segment operation;8 cases were L2/3 dynamic fixation,19 cases were L3/4 dynamic fixation,16 cases were L4/5 dynamic fixation;39 cases were head end dynamic fixation and 4 cases were tail end dynamic fixation.Retrospective analysis was conducted to evaluate the efficacy of lumbar degenerative disease with Topping-off procedure for the prevention of adjacent segment degeneration,which included the following indexes:Improved Oswestry disability index(ODI)and visual analogue score(VAS)of lumbar/leg pain before and after operation;Intervertebral disc improved Pfirrmann classification of dynamic fixed segment and adjacent segment;Intervertebral disc space height and range of motion of dynamic fixed segment and adjacent segment.Results:All the patients completed the operation successfully and were followed up for 12 months,and no nerve injury or complications related to implants occurred;The average operation time was 107±16 minutes(90-150 minutes),the average intraoperative blood loss was 280±72ml(200-450ml),the average hospital stay was 9±2 days(7-12 days);The ODI and VAS of lumbar/leg pain at 3 months and 1 year after operation were significantly better than those before operation(P<0.05);There was no significant difference in Pfirrmann grading between preoperative and postoperative 1 year with dynamic fixation of segments and their adjacent segments(P>0.05),but when the dynamic fixation of segment Pfirrmann grade was lower than or equal to grade V,there was significant difference between preoperative and postoperative 1 year(P<0.05);There was no significant difference in ROM and DSH of dynamic fixation segment and its adjacent segments before operation,3 months after operation and 1 year after operation(P>0.05).Conclusions:Dynamic fixation pedicle screw in lumbar degenerative disease with Topping-off procedure has a good early clinical effect,can provide a certain degree of motion for adjacent segments of lumbar fusion,effectively maintain the height of intervertebral space and intervertebral disc status,and provide powerful conditions for reducing or delaying the occurrence and development of mid and long-term ASD.