非融合稳定弹性棒固定系统和髓核摘除椎间融合椎弓根钉棒固定系统治疗腰椎退行性变的效果比较

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摘要目的比较非融合稳定弹性棒固定系统和髓核摘除椎间融合椎弓根钉棒固定系统治疗腰椎退行性变的效果。方法选取2016年12月～2018年6月深圳市宝安区福永人民医院需行手术治疗的40例严重腰椎退行性变患者作为研究对象，使用随机抽签法将其分为动态固定组和融合固定组，每组各20例。其中动态固定组患者不摘除髓核的同时使用椎弓根弹性棒内固定系统治疗，融合固定组患者常规行髓核摘除椎间融合椎弓根钉棒系统内固定治疗。比较两组患者术前和术后腰痛、下肢痛疼痛视觉模拟评分法（VAS）、Oswestry 功能障碍（ODI）指数、腰椎整体活动度以及术后并发症发生情况。结果 40例患者均顺利完成手术并术后随访。两组患者术后3 d的VAS评分、ODI指数以及腰椎整体活动度比较，差异无统计学意义（P＞0.05）；术后6个月，动态固定组患者的VAS评分以及ODI指数均低于融合固定组，差异有统计学意义（P＜0.05）；术后12、18个月，两组患者的VAS评分以及ODI指数比较，差异无统计学意义（P＞0.05）；术后6、12、18个月，动态固定组患者的腰椎整体活动度均高于融合固定组，差异有统计学意义（P＜0.05）；两组患者术后6、12、18个月与本组术后3 d 比较，腰椎疼痛、功能以及活动度等情况均有改善，差异有统计学意义（P＜0.05）。两组患者均未发生严重的并发症。结论非融合稳定弹性棒固定系统和髓核摘除椎间融合椎弓根钉棒固定系统均是治疗腰椎退行性变的有效手术方式，均可取得良好手术效果。动态固定组具有解除疼痛快、术后腰椎整体活动度恢复快、术后腰椎整体活动度大、降低相邻近节段退变发生率和术后髓核再水化等优势。但动态固定组也存在弹性棒应力变形发生的情况。

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	叶军
	王海涛

关键词 ：腰椎退行性变, 动态固定, 髓核再水化, 融合固定

Abstract：Objective To compare the effect of non-fusion stable elastic rod fixation system and nucleus pulposus removal intervertebral fusion pedicle screw rod fixation system in the treatment of lumbar degeneration.Methods A total of 40 patients with severe lumbar degeneration who required surgery in Fuyong People′s Hospital of Bao′an District in Shenzhen City from December 2016 to June 2018 were selected as the research objects.They were divided into the dynamic fixation group and the fusion fixation group according to the random lottery method, with 20 cases in each group.Patients in the dynamic fixation group were treated with pedicle elastic rod internal fixation system without removing the nucleus pulposus, and patients in the fusion fixation group were routinely treated with nucleus pulposus removal intervertebral fusion pedicle screw rod system internal fixation.The visual analogue scale (VAS) of low back pain, lower extremity pain, the Oswestry dysfunction (ODI) index and overall lumbar spine mobility before and after surgery, and incidence of postoperative complications were compared between the two groups.Results All 40 patients successfully completed the operation and were followed up after the operation.There were no statistically significant differences in the VAS score, ODI index and the overall lumbar spine mobility between the two groups at three days after operation(P＞0.05).At six months after operation, the VAS score and ODI index of the dynamic fixation group were lower than those of the fusion fixation group, the differences were statistically significant (P＜0.05).At 12 and 18 months after surgery, there were no significant differences in the VAS score and ODI index between the two groups (P＞0.05).At 6,12, and 18 months after surgery, the overall lumbar spine mobility of the dynamic fixation group was higher than that of the fusion fixation group, and the difference was statistically significant (P＜0.05).The lumbar spine pain, function and mobility were improved in the two groups at 6, 12, and 18 months after surgery compared with this group at three days after surgery, and the differences were statistically significant (P＜0.05).No serious complications occurred in both groups.Conclusion Both the non-fusion stable elastic rod fixation system and the nucleus pulposus removal intervertebral fusion pedicle screw rod fixation system are effective surgical methods for the treatment of lumbar degeneration,and they can achieve good surgical results.The dynamic fixation group has the advantages of rapid relief of pain, quick recovery of overall postoperative lumbar spine mobility, large postoperative lumbar spine overall mobility, reduced incidence of degeneration of adjacent segments, and rehydration of nucleus pulposus after surgery.But the dynamic fixed group also has stress and deformation of elastic rods.

Key words： Lumbar degeneration Dynamic stabilization Nucleus pulposus regeneration Interbody fusion

基金资助:广东省深圳市宝安区医疗卫生科研项目（2016C X268）

引用本文:

叶军；王海涛. 非融合稳定弹性棒固定系统和髓核摘除椎间融合椎弓根钉棒固定系统治疗腰椎退行性变的效果比较[J]. 中国当代医药, 2021, 28(8): 13-17.
YEJun；WANGHai-tao. Effect comparison of non-fusion stable elastic rod fixation system and nucleus pulposus removal intervertebral fusion pedicle screw rod fixation system in the treatment of lumbar degeneration. 中国当代医药, 2021, 28(8): 13-17.

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http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2021/V28/I8/13

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