中国组织工程研究

中国组织工程研究 ›› 2012, Vol. 16 ›› Issue (44): 8324-8331.doi: 10.3969/j.issn.2095-4344.2012.44.027

• 骨与关节学术探讨 academic discussion of the bone and joint • 上一篇    下一篇

腰椎退变性侧弯植入物置入的内固定治疗

陆 明，马华松，王晓平，牛 晶，任冬云，郑 蕊，张 敬   

  1. 解放军第306医院骨科，全军脊柱外科中心，北京市 100101
  • 收稿日期:2012-08-03 修回日期:2012-09-26 出版日期:2012-10-28 发布日期:2012-10-28
  • 通讯作者: 马华松，主任医师，硕士生导师，解放军第306医院骨科，全军脊柱外科中心，北京市 100101
  • 作者简介:陆明☆，女，1969 年生，吉林省长春市人，汉族，1997 年乌克兰医学科学院创伤矫形研究院毕业，医学博士，副主任医师，副教授，主要从事脊柱外科及生物力学方面的研究。 luming8788@yahoo.com.cn

Internal fixation for the treatment of lumbar degenerative scoliosis

Lu Ming, Ma Hua-song, Wang Xiao-ping, Niu Jing, Ren Dong-yun, Zheng Rui, Zhang Jing   

  1. Department of Orthopedics, Military Center for Spine Surgery, the 306th Hospital of PLA, Beijing 100101, China
  • Received:2012-08-03 Revised:2012-09-26 Online:2012-10-28 Published:2012-10-28
  • Contact: Ma Hua-song, Chief physician, Master’s supervisor, Department of Orthopedics, Military Center for Spine Surgery, the 306th Hospital of PLA, Beijing 100101, China
  • About author:Lu Ming☆, M.D., Associated chief physician, Associate professor, Department of Orthopedics, Military Center for Spine Surgery, the 306th Hospital of PLA, Beijing 100101, China luming8788@yahoo.com.cn

PDF

470

被引次数

9

摘要：

背景：腰椎退行性疾病为骨科常见病之一，是否行手术治疗，以及手术治疗的方法一直以来都存在着很大争议。
目的：分析腰椎退变性侧弯植入物置入内固定治疗的疗效，对患者的症状、腰椎退变节段以及影像学等相关病情进展性的评估，系统回顾相关腰椎退变性疾病的文献。
方法：选取2010年3月至2012年8月在解放军第306医院骨科治疗的腰椎退变性侧弯患者共61例，男30例，女31例；年龄范围在42-78岁，平均年龄59.02岁。其中行腰椎后路减压植入物置入内固定植骨融合患者32例；后路动力系统腰椎置入内固定患者29例。术后随访时间为6-29个月，平均随访时间为16个月。采用目测类比评分、ODI评分、JOA评分系统进行术前、术后以及随访评估。并检索腰椎退变性侧弯植入物置入内固定治疗的相关研究文献，对文献的实验方法和实验结果进行深入分析。
结果与结论：患者的性别和年龄与文献报道中的退变性侧弯发病率、年龄范围相符合。目测类比评分、ODI评分、JOA评分显示术后1个月和3个月评分结果差异无显著性意义(P > 0.05)；术后1年随访时目测类比评分、ODI评分、JOA评分结果差异有显著性意义(P < 0.05)。腰椎后路减压植入物置入内固定适应范围广泛，临床应用时间较长，方法熟悉程度较高，但远期发现顺应性较差，相邻节段退变程度较重，并发症发生率较高。动力内固定系统既能够保证内固定的稳定，也使内固定特性得到较好的发挥，远期随访显示患者对动态固定的顺应性好，达到治疗目的，又保留了患者腰椎的活动。

关键词: 腰椎退变, 脊柱侧弯, 椎间盘突出, 椎管狭窄, 腰椎滑脱, 病程进展, 动态固定系统, 后路减压, 椎弓根螺钉, 相邻节段退变

Abstract:

BACKGROUND: Lumbar degenerative disease is one of the common orthopedic diseases, and there is controversy on the methods of operation and whether the operation should be preformed.
OBJECTIVE: To analyze the effect of internal fixation on the treatment of lumbar degenerative scoliosis, to assess the development of the patient’s symptoms, lumbar renegade segment and imaging, and to systematic review the literatures related degenerative diseases.
METHODS: A total of 61 patients (30 cases in male and 31 cases in female, the age ranged 42-78, average in 59.02) with lumbar degenerative scoliosis were selected from Department of Orthopedics, the 306th Hospital of PLA during March 2010 to August 2012. Among the 61 patients, 32 patients treated with lumbar posterior decompression and internal fixation and fusion; 29 patients treated with lumbar posterior dynamic system. The postoperative follow-up time was 6-29 months, and average in 16 months. Visual Analogue Scale, Oswestry disability Index and Japanese Orthopaedic Association Scores were used for the preoperative, postoperative and follow-up assessment. The literatures on the treatment of lumbar degenerative scoliosis by internal fixation were screened out, and the experimental methods and the results in the literatures were analyzed in-depth.
RESULTS AND CONCLUSION: The gender and age of the patients were consistent with the incidence of lumbar
degenerative scoliosis and age reported in the literatures. Visual Analogue Scale, Oswestry disability Index and Japanese Orthopaedic Association Scores showed that that there was no statistically significant difference at 1 and 3 months postoperation (P > 0.05); at 1 year postoperation, there was statistically significant difference of Visual Analogue Scale, Oswestry disability Index and Japanese Orthopaedic Association Scores (P < 0.05). Lumbar posterior decompression and internal fixation has the advantages of wide adaptation range, longer clinical application time and higher familiarity degree, it has the disadvantages of poor compliance, heavier degeneration degree of adjacent segments and higher incidence of complications. Dynamic fixation system can not only ensure the stability of internal fixation, but also better play the internal fixation characteristics, and the long-term follow-up showed better compliance for the dynamic fixation, therefore had the therapeutic effect, and retained the activities of the patient's lumbar.

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