中国组织工程研究

中国组织工程研究 ›› 2019, Vol. 23 ›› Issue (在线): 1-6.

• 脊柱植入物 spinal implant •    下一篇

单节段Isobar TTL系统动态内固定治疗腰椎退行性疾病的短期临床疗效观察

田一星，包肇华，邹 俊，季一鸣，梅昕，潘 俊，何文野，杨惠林   

  1. 苏州大学附属第一医院骨科，江苏省省苏州市   215006
  • 出版日期:2019-03-28 发布日期:2019-03-28
  • 通讯作者: 杨惠林，教授，博士生导师，苏州大学附属第一医院骨科，江苏省省苏州市 215006
  • 作者简介:田一星，男，1982年生，江苏省泰兴市人，汉族，苏州大学在读博士，目前从事脊柱外科研究。

The clinical effectiveness of single-level Isobar TTL dynamic internal fixation in the treatment of lumbar degenerative diseases

Yixing Tian, Zhaohua Bao, Yiming Ji, Xin Mei, Jun Pan and Huilin Yang   

  • Online:2019-03-28 Published:2019-03-28

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摘要：

文章快速阅读：

 
 

 

文题释义：
Isobar TTL内固定系统：是一种基于椎弓根螺钉的半坚强内固定腰椎后路动态钉棒固定系统，该系统的核心技术在于动态棒包含一个受控动关节，具有±0.4 mm 的纵向位移、±2.25°的伸屈及侧屈三维活动度，能够配合其椎弓根螺钉采用万向钉的潜在运动功能，从而能够使其能在各个运动方向上减少相应椎间盘及小关节承载的负荷，并有效维持间高度及活动度。
临近节段退变：是指腰椎融合节段的邻近节段在治疗后发生退变的现象，是腰椎融合常见的并发症，腰椎融合后出现邻近节段退变的患者可能会出现再发的腰背痛或腰部功能障碍，症状严重的患者甚至需要再次手术治疗，而再次手术治疗的效果多不理想，目前腰椎融合后出现临近节段退变的机制及预防措施仍不完全清楚。
 
摘要
背景：针对动态能固定系统短期临床疗效及能否延缓腰椎治疗后邻近节段退变的问题，临床上存在争议。
目的：探究单节段Isobar TTL系统动态内固定治疗腰椎退行性疾病的短期临床疗效。
方法：回顾性分析了使用单节段Isobar TTL内固定并按时间进行随访的20例患者资料，其中男11例，女9例，平均年龄47.4岁(35-62)岁，使用VAS评分、JOA评分、Oswestry功能障碍指数评估临床疗效，在X线片上测量动态固定节段及其上相邻节段的椎间隙高度、椎间活动度，使用UCLA系统评估动态固定节段及相应的上相邻节段的椎间盘退变情况。
结果与结论：随访患者均顺利完成手术，平均随访时间为14.4个月(12-27个月)。未出现血管、神经损伤、内固定松动、断裂等并发症。20例患者末次随访时VAS评分、JOA评分及Oswestry功能障碍指数较治疗前有明显改善(P < 0.05)，末次随访时动态固定节段活动度较治疗前减小(P < 0.05)，动态固定节段椎间隙高度及UCLA分级与治疗前相比差异无显著性意义(P > 0.05)，上相邻节段椎间隙高度、椎间活动度及椎间盘UCLA分级较治疗前差异无显著性差异(P < 0.05)。提示单节段Isobar TTL动态内固定治疗腰椎退行性疾病疗效满意，短期随访期间未出现动态固定节段及邻近节段椎间盘退变加重。

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 骨科植入物, 动态内固定系统, 半坚强内固定, 临近节段退变, 腰椎退行性疾病, Isobar TTL内固定, 临近节段退变, 目测类比评分, 日本骨科协会评估治疗评分, Oswestry功能障碍指数

Abstract:

BACKGROUND: The short-term effects of dynamic internal fixation and whether dynamic internal fixation system can prevent or delay the process of adjacent level degeneration after lumbar surgery remains in controversy.

Objective: To investigate the short-term clinical effectiveness of single-level Isobar TTL dynamic internal fixation and in the treatment of degenerative lumbar diseases.
Methods: From July 2014 to May 2016, 20 patients who suffered from lumbar degenerative diseases and underwent posterior decompression combined with single-level Isobar TTL dynamic internal fixation , including 11 male patients and 9 female patients, were retrospectively analyzed, the average age of these patients was 47.4. Visual analog scale(VAS), Japanese Orthopaedic Association scores(JOA) and Oswestry disability index(ODI) were used to assess clinical outcomes. Disc height, range of motion(ROM) , and University of California at Los Angeles Grading Scale(UCLA) were measured on X-ray films to evaluate the status of disc degeneration on both dynamic fixed segment(index segment) and superior adjacent segment.
Results: During follow- up, all 20 surgeries were finished successfully without complications. 20 patients were followed from 6 to 27months, with an average of 10.2 months, all the patients showed significant improvements in VAS, JOA and ODI scores(P＜0.05). At the latest follow-up the ROM of index-segment appeared to be smaller than preoperative status. The disc height and UCLA classification on the index segment appeared to have no significant difference compared with those preoperatively. The latest follow-up data, including ROM, disc height and UCLA classification of superior adjacent segment appeared to have no significant difference compared with those preoperatively.
Conclusion: Single-level Isobar TTL dynamic internal fixation proved to have satisfactory clinical outcomes when used in the treatment of lumbar degenerative diseases. During follow-up, no accelerated disc degeneration on either index segment or superior adjacent segment is observed.

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