【摘要】：[目的]在MRI上觀察采用Topping-off技術(shù)置入棘突間裝置(Coflex)后椎間盤的退變情況,并評價近期臨床效果。[方法]2007年8月~2014年11月,107例L5/S1間盤脫出合并L4、L5間盤退變,在本院行手術(shù)治療并隨訪2年以上的患者納入本研究。其中48例僅對L5S1行椎間融合術(shù)(融合組);59例采用Topping-off技術(shù),L5、S1椎間融合術(shù)同時在L4、5棘突間置入Coflex(Topping-off組)。比較兩組術(shù)前及隨訪時VAS、ODI及MRI上L4、5節(jié)段椎間盤相對信號強度(relative signal intensity,RSI)變化情況。[結(jié)果]融合組與Topping-off組患者臨床癥狀均有顯著改善,末次隨訪時兩組的ODI及VAS評分均較術(shù)前明顯下降,差異均有統(tǒng)計學意義(P0.01),但相同時間點兩組間的差異無統(tǒng)計學意義(P0.05)。末次隨訪時MRI上Topping-off組L4、5節(jié)段椎間盤相對信號強度(RSI)顯著高于融合組,兩組間差異有統(tǒng)計學意義(P0.05)。[結(jié)論]腰椎融合術(shù)及Topping-off技術(shù)對于伴節(jié)段不穩(wěn)或伴有劇烈腰痛的腰椎間盤突出癥均有良好且相似的臨床療效,但對于已合并上位鄰近節(jié)段退變的患者,Topping-off技術(shù)緩解患者臨床癥狀的同時更有助于延緩鄰近節(jié)段椎間盤的退變。
[Abstract]:[objective] to observe the degeneration of interspinous device (Coflex) on MRI, and to evaluate the clinical effect in the near future. [methods] from August 2007 to November 2014, 107 patients with L5/S1 intervertebral disc prolapse combined with L4 or L5 disc degeneration were treated surgically in our hospital and followed up for more than 2 years. Among them, 48 cases were treated with intervertebral fusion only for L5S1 (fusion group), and 59 cases were treated with Topping-off technique. L5S 1 intervertebral fusion was performed simultaneously with Coflex (Topping-off group) in L4 5 spinous process. The changes of relative signal intensity (relative signal intensity,RSI) of L4 segment intervertebral disc on VAS,ODI and MRI were compared between the two groups. [results] the clinical symptoms of both the fusion group and the Topping-off group were significantly improved, and the ODI and VAS scores of the two groups were significantly lower than those of the pre-operation at the last follow-up (P0.01), but there was no significant difference between the two groups at the same time (P0.05). At the last follow-up, the relative signal intensity (RSI) of Topping-off group was significantly higher than that of fusion group on MRI (P0.05). [conclusion] Lumbar fusion and Topping-off techniques have good and similar clinical efficacy in the treatment of lumbar disc herniation with segmental instability or severe low back pain. However, for patients with superior proximal segment degeneration, Topping-off can relieve the clinical symptoms and delay the degeneration of adjacent intervertebral disc at the same time.
【作者單位】： 上海交通大學附屬第六人民醫(yī)院脊柱外科;
【基金】：上海市市級醫(yī)院新興前沿技術(shù)聯(lián)合攻關(guān)項目(編號:SHDC2014102)
【分類號】：R687.3

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