發(fā)布時間：2018-06-29 10:51

  本文選題：Topping-off + Cofelx��； 參考：《中國矯形外科雜志》2017年11期

【摘要】：[目的]探討Topping-off與融合固定治療退行性腰椎疾病的臨床療效及對比性研究鄰近節(jié)段的退變情況。[方法]回顧性研究2010年1月~2013年12月本院收治的99例L3~5退行性腰椎病變患者。根據(jù)手術方式不同,分為Topping-off組(L_(4~5)PLIF+L_(3~4)Coflex)45例,男21例,女24例,平均年齡61.50歲(46~77歲);融合固定組(L3~5PLIF)54例,男25例,女29例,平均年齡63.70歲(50~75歲)。記錄手術時間、術中出血量及術后并發(fā)癥。選用Oswestry功能障礙指數(shù)(Oswestry disability index,ODI)、視覺模擬評分(visual analogue scale,VAS)評價臨床療效。拍攝腰椎平掃MRI及站立位正側屈伸位X線片,測量并記錄術前、術后2年鄰近節(jié)段L2-3椎間活動度及椎間盤MRI改良Pfirrmman分級,術前、術后2年Coflex置入節(jié)段L_(3~4)的椎間活動度,術后2年Topping-off組復合鄰近節(jié)段活動度(Coflex置入節(jié)段L_(3~4)與其上位節(jié)段L_(2~3)椎間活動度之和)。[結果]平均隨訪時間(35.20±7.80)月(24~48月)。Topping-off組手術時間、出血量明顯小于融合固定組(P0.05)。術后2年腰痛及腿痛VAS、ODI評分與術前比較,兩組均有明顯好轉(P0.05)。術后2年L_(2~3)椎間活動度,與術前比較Topping-off組無明顯變化(P0.05),融和固定組明顯增加(P0.05);組間比較Topping-off組明顯小于融合固定組(P0.05)。術后2年Topping-off組復合鄰近節(jié)段活動度與融合固定組L_(2~3)椎間活動度比較,差異無統(tǒng)計學意義(P0.05)。術后2年腰椎MRI顯示L_(2~3)椎間盤改良Pfirrman分級,Topping-off組明顯優(yōu)于融合固定組(P0.05)。[結論]Topping-off對比融合固定治療退行性腰椎疾病,具有創(chuàng)傷小、出血少、臨床效果相似的特點,Coflex置入節(jié)段承擔近端腰椎部分活動與應力,有助于減緩鄰近節(jié)段的退變。
[Abstract]:[objective] to investigate the clinical efficacy of Topping-off and fusion fixation in the treatment of degenerative lumbar spine disease and to study the degenerative status of adjacent segments. [methods] A retrospective study of 99 patients with L3 + 5 degenerative lumbar spondylopathy from January 2010 to December 2013 was performed. According to the different operation methods, there were 45 cases of Topping-off group (L _ (4N) PLIF _ (3) Coflex), 21 males and 24 females, with an average age of 61.50 years (4677 years) and 54 cases of fusion fixation group (L3 + 5PLIF), including 25 males and 29 females, with an average age of 63.70 years (50 / 75 years). The operative time, blood loss and postoperative complications were recorded. Oswestry disability index (ODI) and visual analogue score (visual analogue scale VAS) were used to evaluate the clinical efficacy. L2-3 intervertebral motion and modified Pfirrmman grade of intervertebral disc were measured and recorded before operation, 2 years after operation, 2 years before and 2 years after Coflex were implanted into L3 4 segment of lumbar vertebrae before and 2 years after Coflex implantation of intervertebral motion of lumbar vertebrae and lateral flexion and extension of lumbar vertebrae, and the intervertebral motion of adjacent segment L2-3 and modified Pfirrmman grade of disc MRI were measured and recorded before and 2 years after operation. Two years after operation, Topping-off group combined with adjacent segment motion (the sum of Coflex insertion of L3F4 and L2T3). [results] the mean follow-up time was (35.20 鹵7.80) months (24-48 months). The blood loss in Topping-off group was significantly lower than that in fusion fixation group (P0.05). Two years after operation, VAS-ODI scores of low back pain and leg pain were significantly improved in both groups compared with those before operation (P0.05). There was no significant change in L2F3 intervertebral activity in the Topping-off group (P0.05), but significantly increased in the fusion fixation group (P0.05), and the comparison between the Topping-off group and the fusion fixation group (P0.05) was less than that in the Topping-off group (P0.05). 2 years after operation, there was no significant difference between the combined adjacent segment motion of Topping-off group and the fusion fixation group (P 0.05). 2 years after operation, the L2T3 modified Pfirrman classification was significantly superior to that of the fusion fixation group in Topping-off group (P0.05). [conclusion] Topping-off fusion fixation for degenerative lumbar degenerative diseases has the characteristics of less trauma, less bleeding and similar clinical effect. Coflex is placed into the segment to undertake some activities and stresses of the proximal lumbar vertebrae, which is helpful to slow down the degeneration of adjacent segments.
【作者單位】： 首都醫(yī)科大學附屬北京朝陽醫(yī)院骨科;
【分類號】：R687.3

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