融合联合动态固定治疗多节段腰椎退变性疾病

Spinal fusion hybridized with dynamic fixation for multi-level lumbar degenerative diseases

[目的]评价融合联合动态固定治疗多节段腰椎退变性疾病的临床疗效。[方法]2017年8月—2019年3月采用融合联合动态固定技术治疗多节段腰椎退变性疾病患者56例。观察临床与影像资料。[结果]所有患者手术顺利完成,螺钉置入位置准确,无神经根以及马尾神经医源性损伤。手术节段L_(3-5)31例,其中26例融合L_(4/5),5例融合L_(3/4);L_(4)~S_(1)25例,其中21例融合L_(4/5),4例融合L_(5)S_(1)。随访(23.23±7.34)个月,末次随访时腰痛和腿痛VAS评分,及ODI评分均显著降低(P<0.05),而JOA评分显著增加(P<0.05)。影像方面,与术前相比,末次随访时融合节段的椎间隙高度显著增大(P<0.05),而节段ROM消失;非融合节段椎间隙高度无变化(P>0.05),ROM显著减小(P<0.05)。所有患者无内置物松动、移位。[结论]融合联合动态固定治疗多节段腰椎退变性疾病临床结果满意。

[Objective]To evaluate the clinical efficacy of spinal fusion hybridized with dynamic fixation for multi-level lumbar degenerative diseases.[Methods]From August 2017 to March 2019,a total 56 patients underwent spinal fusion hybridized with dynamic fixation for multi-level lumbar degenerative diseases in our department.The clinical and imaging documents were observed and analyzed.[Results]All patients had operation performed successfully with accurate screw placement and no iatrogenic injuries to nerve roots or cauda equina.Of them,31 patients had lesions from L_(3) to L_(5),including 26 patients with L_(4/5)fusion and 5 patients with L_(3/4)fusion,while the remaining 25 patients were from L_(4) to S_(1),including 21 patients with L_(4/5)fusion and 4 patients with L_(5)~S_(1)fusion.At the latest follow-up lasted for(23.23±7.34)months on an average,the VAS scores for low back pain and leg pain,as well as ODI scores significantly decreased(P<0.05),while JOA score significantly increased compared with those preoperatively(P<0.05).In term of imaging evaluation,the intervertebral space height in the fused segment significantly increased(P<0.05),while the ROM disappeared at the latest follow-up compared with those before operation.By contrast,in the non-fusion segment intervertebral space height remained unchanged(P>0.05),with significantly decreased ROM(P<0.05).No loosening and displacement of the implants were noted in anyone of them until the latest follow-up.[Conclusion]The spinal fusion hybridized with dynamic fixation does achieve satisfactory clinical consequences for multi-level lumbar degenerative diseases.