本文選題：動(dòng)態(tài)固定 + lsobar　； 參考：《北京中醫(yī)藥大學(xué)》2015年碩士論文

【摘要】：背景腰椎退行性疾病是造成腰腿痛的常見(jiàn)及主要原因,經(jīng)保守治療,療效不理想的患者,應(yīng)考慮手術(shù)治療。脊柱融合技術(shù)至今,已歷經(jīng)了1個(gè)多世紀(jì)的發(fā)展,經(jīng)過(guò)長(zhǎng)期大量的臨床研究,證實(shí)了其安全性和有效性,被廣大的脊柱外科醫(yī)師認(rèn)定為治療脊柱疾病經(jīng)典的手術(shù)方式。但椎間融合固定后改變了脊柱正常的生物力學(xué),脊柱融合后,因?yàn)槿诤瞎?jié)段僵直,脊柱為保持其活動(dòng)范圍,導(dǎo)致鄰近節(jié)段的活動(dòng)范圍代償性增加,鄰近椎間盤及關(guān)節(jié)突關(guān)節(jié)負(fù)荷增加,導(dǎo)致鄰近節(jié)段退行性改變,尤其對(duì)于術(shù)前就已經(jīng)存在鄰近節(jié)段椎間盤脫水、變性者。融合術(shù)后,鄰近節(jié)段退變發(fā)病率增高明顯。IsobarTTL動(dòng)態(tài)內(nèi)固定系統(tǒng)理論上具有穩(wěn)定腰椎,維持椎間隙高度、保留動(dòng)態(tài)固定節(jié)段一定的活動(dòng)度的作用,在一定程度上預(yù)防,延緩鄰近節(jié)段退變的發(fā)生。目的1.評(píng)價(jià)IsobarTTL動(dòng)態(tài)固定系統(tǒng)治療腰椎退行性疾病的短期臨床療效。2.初步探討Isobar TTL動(dòng)態(tài)固定系統(tǒng)對(duì)鄰近節(jié)段的保護(hù)作用。方法2013年3月至2014年12月東直門醫(yī)院骨科采用Isobar TTL動(dòng)態(tài)固定系統(tǒng)單節(jié)段動(dòng)態(tài)非融合治療腰椎退行性疾病共30例,術(shù)后7d后行腰椎X片復(fù)查,患者出院時(shí)囑其門診定期復(fù)查隨訪,復(fù)查腰椎正側(cè)、前屈、后伸位片,測(cè)量動(dòng)態(tài)固定節(jié)段活動(dòng)度,椎間隙高度指數(shù),采用UCLA系統(tǒng)評(píng)價(jià)椎間盤退變情況；記錄VAS視覺(jué)模擬評(píng)分、ODI功能障礙指數(shù),末次隨訪根據(jù)改良的Macnab療效評(píng)定標(biāo)準(zhǔn)評(píng)價(jià)患者總體療效。結(jié)果30例患者順利完成手術(shù),隨訪時(shí)間術(shù)(6-18個(gè)月),平均隨訪時(shí)間10個(gè)月,術(shù)后各隨訪時(shí)間點(diǎn)VAS評(píng)分、ODI評(píng)分較術(shù)前均明顯下降,差異有統(tǒng)計(jì)學(xué)意義。末次隨訪時(shí)臨床療效評(píng)價(jià)以改良的MacNab標(biāo)準(zhǔn),其中優(yōu)20例,良8例,可2例,差0例,優(yōu)良率93.33%,末次隨訪時(shí),所有患者均未發(fā)現(xiàn)內(nèi)固定物移位,斷裂等并發(fā)癥。動(dòng)態(tài)固定節(jié)段的ROM隨訪時(shí)均較術(shù)前明顯下降,差異有統(tǒng)計(jì)學(xué)意義(p0.01),動(dòng)態(tài)固定節(jié)段ISR隨訪時(shí)與術(shù)前相比,較術(shù)前略下降,與術(shù)前相比無(wú)統(tǒng)計(jì)學(xué)意義(p0.05),鄰近節(jié)段退變無(wú)明顯進(jìn)展。結(jié)論Isobar TTL動(dòng)態(tài)固定系統(tǒng)治療腰椎退行性疾病具有較好的近期臨床療效,該動(dòng)態(tài)固定系統(tǒng)在維持了動(dòng)態(tài)固定節(jié)段穩(wěn)定性的同時(shí),能夠保留其一定的運(yùn)動(dòng)功能,并能于術(shù)后良好的維持動(dòng)態(tài)固定節(jié)段的椎間隙高度。該動(dòng)態(tài)固定系統(tǒng)對(duì)鄰近節(jié)段的影響較小,在一定程度上可以延緩鄰近節(jié)段退變。但是本研究隨訪時(shí)間短,樣本量偏少。末證明其優(yōu)點(diǎn),應(yīng)與堅(jiān)強(qiáng)內(nèi)固定系統(tǒng)對(duì)比,需要進(jìn)一步的隨機(jī),對(duì)照,前瞻的臨床研究。
[Abstract]:Background Lumbar degenerative disease is a common and main cause of low back and leg pain.The spinal fusion technology has been developed for more than a century. It has been proved to be safe and effective by a large number of clinical studies for a long time. It has been recognized by the majority of spinal surgeons as the classic surgical treatment for spinal diseases.But intervertebral fusion and fixation changed the normal biomechanics of the spine. After spinal fusion, because of the rigidity of the fusion segment, the spinal column maintained its range of activities, which resulted in the compensatory increase of the range of activities of the adjacent segments.The load of adjacent intervertebral disc and articular facet joint increased, resulting in degenerative changes of adjacent segment, especially for those with dehydration and degeneration of adjacent intervertebral disc before operation.After fusion, the incidence of degeneration in adjacent segments was significantly increased. Isobar TTL dynamic internal fixation system could stabilize the lumbar vertebrae, maintain the height of intervertebral space, and retain a certain range of motion of the dynamic fixation segment, so as to prevent it to a certain extent.Delay the occurrence of adjacent segment degeneration.Objective 1.To evaluate the short-term clinical effect of IsobarTTL dynamic fixation system in the treatment of lumbar degenerative diseases.The protective effect of Isobar TTL dynamic fixation system on adjacent segments was preliminarily discussed.Methods from March 2013 to December 2014, 30 cases of lumbar degenerative diseases were treated with Isobar TTL dynamic fixation system.The lumbar disc degeneration was evaluated by UCLA system, and the VAS visual analogue score was recorded, and the dysfunction index was recorded, and the dynamic fixed segment motion and intervertebral space height index were measured by reexamination of lumbar vertebrae anterograde, flexion and extension of lumbar vertebrae, and UCLA system was used to evaluate the degenerative status of intervertebral disc.The final follow-up was conducted to evaluate the overall efficacy of the patients according to the modified Macnab criteria.Results the operation was successfully completed in 30 patients, and the average follow-up time was 10 months. The VAS scores at all postoperative follow-up time points were significantly lower than those before operation, and the difference was statistically significant.At the last follow-up, the clinical efficacy was evaluated according to the modified MacNab standard, including excellent 20 cases, good 8 cases, fair 2 cases, poor 0 cases, excellent and good rate 93.33. At the last follow-up, no internal fixation displacement, fracture and other complications were found in all the patients.The ROM of dynamic fixed segment was significantly lower than that of preoperation, and the difference was statistically significant (p 0.01). The ISR of dynamic fixed segment was slightly lower than that of preoperation, and had no significant difference with that of preoperation. There was no significant progress in degeneration of adjacent segment.Conclusion Isobar TTL dynamic fixation system is effective in the treatment of lumbar degenerative diseases in the near future. The dynamic fixation system can maintain the stability of dynamic fixation segment while preserving its motor function.The height of intervertebral space can be maintained well after operation.The dynamic fixed system has little effect on the adjacent segments, which can delay the degeneration of the adjacent segments to some extent.However, the follow-up time of this study is short and the sample size is small.The proven advantages should be compared with a strong internal fixation system, requiring further randomized, controlled, and prospective clinical research.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3

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