Isobar TTL系统治疗腰椎退行性疾病的疗效及术后融合率的探讨

目的：评价Isobar TTL动态内固定系统治疗腰椎退行性疾病的疗效并探讨术后融合率。方法：对2013年4月至2016年1月行Isobar TTL动态固定系统治疗的腰椎退行性疾病80例患者进行回顾性分析，其中男39例，女41例；年龄28～69岁，平均46.4岁；单节段42例，双节段38例。临床疗效采用疼痛视觉模拟评分（visual analogue scale，VAS）、Oswestry功能障碍指数（Oswestry Disability Index，ODI）评分、改良Macnab评价标准进行评估。通过影像学资料测量椎间活动度（rang of motion，ROM），椎间隙高度比值（intervertebral space height ratio，ISR），按照SUK等制定的标准评定动态固定节段的融合情况。结果：80例患者均获得临床随访，时间17～45个月，平均31.9个月，共有30例患者完成影像学复查。80例患者术前VAS、ODI评分分别为9.15±1.55，38.65±9.60，术后2周分别为0.55±1.18，1.06±2.17，末次随访分别为0.24±0.70，0.16±0.48，术后2周及末次随访VAS、ODI评分较术前均明显下降（P<0.05）；末次随访按照改良Macnab评价标准，优65例，良14例，可1例。完成影像学复查的30例患者动态固定节段ROM值术前（6.87±2.18）°，术后2周及末次随访降低至（3.52±2.80）°，（3.14±2.60）°（P<0.05）；邻近节段ROM值术前（4.36±1.28）°，术后2周及末次随访提高至（4.80±1.99）°，（6.54±4.83）°（P<0.05）。动态固定节段与邻近节段术前的ISR值分别为（36.73±6.36）%，（40.74±7.29）%，术后2周提高为（38.37±6.35）%，（41.59±7.77）%（P<0.05），末次随访降低为（36.58±9.53）%，（38.25±8.08）%，较术前差异无统计学意义（P>0.05）。30例完成影像学复查的患者，可能融合20例，不融合10例。结论：Isobar TTL动态内固定系统治疗腰椎退行性疾病可以取得很好的临床疗效，虽然增加了邻近节段的活动度，但短期仍可有效防止邻近节段退变，动态固定节段有融合倾向。

Therapeutic effect of Isobar TTL fixation system on lumbar degenerative disease and discussion on postoperative fusion rate

Objective:To evaluate the therapeutic effect of Isobar TTL dynamic internal fixation system on lumbar degenerative disease and to explore the postoperative fusion rate.Methods:The clinical data of 80 patients with lumbar degenerative disease underwent Isobar TTL dynamic internal fixation system from April 2013 to January 2016 were retrospectively analyzed. There were 39 males and 41 females,aged from 28 to 69 years old with an average of 46.4 years,42 cases of single segment and 38 cases of double segments. Visual analogue scale (VAS),Oswestry Disability Index (ODI) and the modified Macnab criteria were used to evaluate the clinical effects. The intervertebral range of motion (ROM) and intervertebral height ratio (ISR) were measured by X-ray films. According to the standard established by SUK to evaluate the intervertebral fusion of dynamic fixed segment.Results:All the patients were followed up for 17 to 45 months with an average of 31.9 months,a total of 30 cases completed imaging review. VAS and ODI scores of 80 cases respectively were 9.15±1.55,38.65±9.60 before operation,0.55±1.18,1.06±2.17 at 2 weeks after operation,0.24±0.70,0.16±0.48 at the final follow-up. The VAS and ODI scores at 2 weeks and the final follow-up were significantly lower than those preoperative(P<0.05). At the final follow-up,according to modified Macnab criteria to evaluate the clinical effect,65 cases obtained excellent results,14 good,1 fair. In the 30 cases completed imaging review,the ROM of the dynamic fixed segment was decreased from (6.87±2.18)° preoperatively to (3.52±2.80)°,(3.14±2.60)° at 2 weeks after operation and at the final follow-up(P<0.05). The ROM of the adjacent segment was increased from (4.36±1.28)° preoperatively to (4.80±1.99)°,(6.54±4.83)° at 2 weeks after operation and at the final follow-up(P<0.05). The ISR of dynamic fixed segment and adjacent segment were increased from (36.73±6.36)%,(40.74±7.29)% preoperatively to (38.37±6.35)%,(41.59±7.77)% at 2 weeks postoperatively(P<0.05),and at the final follow-up were decreased to (36.58±9.53)%,(38.25±8.08)%,there was no significant difference between preoperative and the final follow-up(P>0.05). Among them,20 cases got possible fusion and 10 cases got non-fusion,with the possible fusion rate of 66.7%.Conclusion:Isobar TTL dynamic internal fixation system has a good clinical effect in the treatment of lumbar degenerative disease. Although the ROM of adjacent segments is increased,it can effectively prevent the degeneration of the adjacent segments in the short term. And the dynamic fixation segment tends to fusion.