腰椎融合联合邻近节段K-Rod动态固定治疗腰椎退行性疾病

[目的]观察单节段腰椎后路椎间融合联合邻近节段K-Rod动态固定术治疗腰椎退行性疾病的临床疗效。[方法]回顾性分析2010年6月~2012年9月手术治疗的50例腰椎退行性疾病患者的临床资料,根据手术方式不同分为2组:单节段腰椎后路融合联合邻近节段K-Rod动态固定术组(A组)和单节段腰椎后路融合术组(B组),其中A组男14例,女11例;平均年龄(41.2±5.6)岁;B组男12例,女13例;平均年龄(47.4±5.2)岁。评估两组患者的神经改善情况、腰椎总活动度、近端邻近节段活动度及椎间隙高度情况。[结果]随访时间12~25个月,平均16.7个月。无不可逆性神经症状加重、内置物失败等并发症,临床疗效满意。在末次随访时,两组患者术后VAS及ODI评分均获得显著改善(P<0.05);A组动态固定节段的活动度术前(8.50±0.76)°,末次随访(3.45±0.49)°,存在统计学差异(P<0.05);A组动态固定节段的近端临近节段的活动度术前(7.62±0.50)°,末次随访(7.87±0.62)°,无统计学差异;B组近端临近节段活动度术前(8.20±1.13)°,末次随访(8.90±1.03)°,存在统计学差异(P<0.05);在末次随访时,两组腰椎总活动度及椎间隙高度均无统计学差异(p>0.05)。[结论]腰椎后路融合联合邻近节段K-Rod动态固定术治疗腰椎退行性疾病早期疗效明确,能够维持一定的脊柱生物学功能,并能避免相邻节段退变的进展,但远期疗效有待进一步观察。     

非融合技术与腰椎融合术治疗腰椎退变性疾病的早期疗效观察

目的探讨Dynesys和腰椎融合治疗腰椎退行性疾病早期临床疗效。方法采用两种方法治疗36例腰椎退行性疾病患者,Dynesys组18例,腰椎融合组18例。观察两组手术时间、术中出血量、VAS评分、ODI指数、手术效果优良率及椎间活动度(ROM)。结果两组术后VAS及ODI都得到明显改善;Dynesys组邻近节段ROM维持在原来状态,手术节段ROM减小;腰椎融合组邻近节段ROM增大,手术节段融合。结论Dynesys与腰椎融合术均可取的理想的早期疗效,Dynesys保持了部分椎间活动度,有利于防止退变加速。     

退行性腰椎侧凸后路固定减压选择性植骨融合术后邻近节段退变的临床分析

目的观察后路椎弓根钉内固定、椎管减压、选择性椎间植骨融合术治疗退行性腰椎侧凸术后邻近节段退变发生的情况。方法回顾性分析自2012-01—2015-12采用后路椎弓根钉内固定、椎管减压、选择性椎间植骨融合术治疗的72例退行性腰椎侧凸,A组35例选择L4、5节段融合,B组37例选择L5S1节段融合。比较2组多节段固定比例、多椎板间隙减压比例,术后1周矢状面Cobb角、冠状面Cobb角、JOA评分,以及邻近节段退变发生率。结果 A组随访(14.1±1.2)个月,B组随访(12.8±0.2)个月。A组单椎板间隙减压比例低于B组,且多椎板间隙减压比例高于B组,多节段固定比例明显高于B组,差异有统计学意义(P 0.05)。B组1周矢状面Cobb角大于A组,差异有统计学意义(P 0.05);但2组术后1周冠状面Cobb角、JOA评分差异无统计学意义(P0.05)。A组邻近节段退变发生率明显高于B组,差异有统计学意义(P 0.05)。结论后路椎弓根钉内固定、椎管减压、选择性椎间植骨融合术治疗退行性腰椎侧凸时,固定、减压节段越多,术后发生邻近节段退变的概率越大。     

Wiltse入路Dynesys内固定术与TLIF治疗老年腰椎椎管狭窄症的早期疗效对比分析

目的评估Wiltse入路Dynesys内固定术及Wiltse入路经椎间孔腰椎椎间融合术(TLIF)治疗老年单节段腰椎椎管狭窄症的临床疗效。方法回顾性分析2013年1月—2015年1月本院收治的35例老年单节段腰椎椎管狭窄患者的临床资料,其中采用Wiltse入路Dynesys内固定术15例(Dynesys组),Wiltse入路TLIF 20例(TLIF组);随访时间12~18个月,平均16个月。比较两组患者围术期指标(手术时间、术中出血量、术后引流量),术前及术后疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)、手术节段和邻近节段活动度(ROM)。结果 Dynesys组手术时间、术中出血量、术后引流量均低于TLIF组,差异有统计学意义(P0.05)。Dynesys组术后5 d腰背痛VAS评分及ODI均优于TLIF组,差异有统计学意义(P0.05);腿痛VAS评分两组间差异无统计学意义(P0.05)。末次随访时两组患者腰痛和腿痛VAS评分及ODI均较术前明显改善,差异有统计学意义(P0.05);两组间比较,差异无统计学意义(P0.05)。Dynesys组固定节段ROM较术前减小,TLIF组固定节段ROM降至0°,与术前相比差异均有统计学意义(P0.05)。Dynesys组上下邻近节段末次随访时的ROM较术前无明显改变,TLIF组上下邻近节段末次随访时ROM均较术前升高,差异均有统计学意义(P0.05);两组间比较,差异有统计学意义(P0.05)。结论 Wiltse入路具有出血量少、手术创伤小、术后恢复快的优点。相较于TLIF,Dynesys技术不需要支具外固定,允许早期活动,因不需植骨融合而避免了假关节的形成,能够保留固定节段部分ROM,减少邻近节段的过度活动,在治疗老年腰椎椎管狭窄症中具有独特优势。     

经Wiltse入路Dynesys内固定治疗腰椎退行性疾病的近期疗效

目的探讨经Wiltse入路Dynesys内固定治疗腰椎退行性疾病的临床疗效。方法回顾性分析自2013-03—2016-09采用经Wiltse入路Dynesys内固定治疗的22例腰椎退行性疾病。比较术前、术后3个月、末次随访时JOA评分、椎间隙高度、椎体活动度。结果 22例均获得随访,随访时间平均23(15~32)个月。术后3周时1例发生多裂肌失神经纤颤电位现象。术后3个月JOA评分较术前明显增加,差异有统计学意义(P 0.05),但末次随访时JOA评分与术后3个月比较差异无统计学意义(P0.05)。术前、术后3个月、末次随访时手术节段及邻近节段椎间隙高度差异无统计学意义(P0.05)。术后3个月手术节段椎体活动度较术前降低,差异有统计学意义(P 0.05);但末次随访时手术节段活动度与术后3个月比较差异无统计学意义(P0.05)。术前、术后3个月、末次随访时手术上位节段活动度及下位节段活动度比较差异无统计学意义(P0.05)。结论经Wiltse入路Dynesys内固定治疗腰椎退行性疾病避免对多裂肌的损伤,保留了腰椎固定节段的活动度,降低了邻近节段退变发生率,近期疗效满意。     

动态稳定与融合治疗单节段退行性腰椎滑脱比较

[目的]前瞻性对比分析Dynesys动态稳定与融合治疗单节段退行性腰椎滑脱的临床疗效.[方法]2013年1月-2016年6月46例单节段退行性腰椎滑脱患者随机分为两组,其中,22例采用Dynesys动态稳定(Dynesys组),24例采用后路融合固定(PLIF组).比较两组围手术期、随访期及影像学资料.[结果]两组患者...     

同节段出口根减压对严重腰椎间盘脱出症治疗的影响

目的研究同节段出口根减压对严重腰椎间盘脱出手术效果的影响,探讨同节段出口根减压与腰椎术后邻近节段退变的关系。方法选择70例严重腰椎间盘脱出症患者,将其随机分为两组,所有患者均行腰椎后路全椎板减压植骨融合内固定术。实验组:术中对双侧同节段出口根进行充分减压;对照组:未对同节段出口根进行减压。对两组进行JOA评分,测量术后腰椎动力位像上手术邻近节段椎间隙高度和椎间活动度。结果实验组与对照组JOA改善指数比较有统计学意义(P<0.05),两组间术前与术后椎间高度差及邻近节段椎间活动度变化比较无明显统计学意义(P>0.05)。结论对于严重腰椎间盘脱出症患者行腰椎后路椎间融合术+同节段出口根减压术,可以有效缓解腰腿痛症状,并且术后6个月内不会增加邻近节段退变的危险。     

Dynesys动态中和内固定系统的生物力学机制研究进展

腰椎退变性疾病主要包括腰椎间盘突出、腰椎管狭窄、腰椎节段性不稳、退变性椎体滑脱及退行性脊柱侧凸等,保守治疗通常无效,往往需要手术干预.Dynesys动态中和内固定系统(dynamic neutralization system,Dynesys)作为一种后路非融合内固定装置,目前已被广泛用来治疗腰椎退变性疾病.与传统融合术不同的是,它能够在提供稳定内固定的基础上,有效改善固定节段的应力传导,保留固定节段的活动度(range of motion,ROM),减小临近节段退变疾病(adjacent segments degeneration,ASD)的发生率.现通过阅读相关文献,将Dynesys系统的设计理念及其生物力学机制研究现状综述如下.     

肌间隙入路Dynesys固定与TLIF手术治疗老年腰椎管狭窄症的临床比较

目的 对比经Wiltse肌间隙入路Dynesys固定与经椎间孔腰椎椎体间融合术(transforaminal lumbar interbody fusion,TLIF)治疗老年腰椎管狭窄症的疗效。方法 纳入2015年1月～2017年4月收治的89例老年腰椎管狭窄症患者,术后均随访2年以上,将47例经TLIF手术治疗者设为TLIF组,42例经Wiltse入路Dynesys固定者设为Dynesys组。比较两组手术情况及上、下邻近节段活动度,比较邻近节段退变(adjacent segment degeneration,ASD)发生情况。结果 两组手术时间差异无统计学意义(P0.05),Dynesys组住院时间、手术出血量显著低于TLIF组,差异有统计学意义(P0.05);两组术前、术后1个月、末次随访的ODI指数、VAS评分差异无统计学意义(P0.05); TLIF组末次随访时,手术节段上、下邻近节段活动度均显著增加,而Dynesys组末次随访时的邻近节段活动度显著低于TLIF组,差异有统计学意义(P0.05); Dynesys组ASD发生率显著低于TLIF组,差异有统计学意义(P0.05)。结论 经Wiltse入路Dynesys固定与TLIF手术治疗老年腰椎管狭窄症能获得一致的远期疗效,但前者手术创伤更小,且能保留手术节段活动度,避免手术后邻近节段的过度活动,降低ASD发生风险。     

动态中和系统与后路腰椎椎间融合治疗腰椎退行性变的比较研究

目的探讨动态中和系统(dynamic neutralization system,Dynesys)治疗腰椎退行性变的近期疗效,比较与后路腰椎椎间融合(posterior lumbar interbody fusion,PLIF)的疗效差异。方法回顾性分析2009年2月-2011年3月分别采用Dynesys(14例)和PLIF(18例)治疗的腰椎退行性变患者临床资料。两组患者性别、年龄、病程、病变类型、病变节段等比较,差异均无统计学意义(P>0.05),具有可比性。对两组术前及末次随访时疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)和影像学评估结果进行比较分析。结果术后31例获随访,随访时间12～21个月,平均17个月。随访期间两组均无内固定物松动、断钉、断棒、断索等并发症发生。PLIF组椎间均骨性融合或接近融合,融合时间13～19个月,平均15个月。两组末次随访时VAS评分、ODI均较术前显著改善(P<0.05);术前及末次随访时两组间比较差异均无统计学意义(P>0.05)。影像学评估:末次随访时PLIF组手术节段活动度(rangeof motion,ROM)为(0.1±0.4)°,与术前(7.0±0.6)°比较差异有统计学意义(t=28.500,P=0.004);Dynesys组手术节段ROM(5.0±1.5)°较术前(7.5±0.8)°减少,但差异无统计学意义(t=0.480,P=0.113);末次随访时两组间比较差异有统计学意义(t=5.260,P=0.008)。末次随访时Dynesys组邻近节段ROM(7.2±0.7)°较术前(7.3±1.8)°减小,但差异无统计学意义(t=0.510,P=0.108);PLIF组邻近节段ROM(8.7±0.4)°较术前(7.0±1.6)°明显增加,差异有统计学意义(t=3.440,P=0.042);末次随访时两组间比较差异有统计学意义(t=—2.100,P=0.047)。结论 Dynesys与PLIF治疗腰椎退行性变的近期疗效相当,但Dynesys具有保留手术节段ROM、不增加邻近节段ROM的优势,同时具有促进手术节段椎间盘恢复、预防相邻节段退变的积极作用。     

Dynesys动态内固定与融合术治疗腰椎退变疾病的对比研究

目的 比较Dynesys动态内固定与腰椎后路椎间融合术（posterior lumbar interbody fusion,PLIF）治疗腰椎退变疾病的临床疗效和影像学结果.方法回顾分析2008年7月-2011年3月采用Dynesys 动态固定治疗且随访时间＞2年的腰椎退变患者46例（Dynesys组）,以同期行PLIF的50例患者作为对照（PLIF组）.记录2组手术前后Oswestry 功能障碍指数（Oswestry disability index,ODI）和疼痛视觉模拟量表（visual analogue scale,VAS） 评分,摄腰椎正侧位和前屈后伸位X线片,测量手术节段椎间高度、活动度（range of motion,ROM）以及近侧邻近节段的椎间ROM,评估2组影像学和症状学邻近节段退变的发生情况.结果 2组患者术前资料差异无统计学意义,末次随访时的ODI及VAS评分均较术前明显改善（P＜0.05）,组间差异无统计学意义（P＞0.05）.末次随访时Dynesys组手术节段椎间高度较术前轻度升高（P＞0.05）,而PLIF组显著升高（P＜0.05）且大于Dynesys组,组间差异有统计学意义（P＜0.05）.Dynesys组手术节段ROM由术前的7.1°降至末次随访时的4.9°（P＜0.05）,而PLIF组手术节段ROM由术前的7.3°降至末次随访时的0°（P＜0.05）.2组近侧邻近节段椎间高度变化差异无统计学意义（P＞0.05）,ROM在末次随访时均较术前有所增加（P＜0.05）,且PLIF组大于Dynesys组（P＜0.05）.Dynesys组有6例患者出现影像学邻近节段退变,PLIF组患者有15例出现影像学邻近节段退变,差异有统计学意义（P＜0.05）,仅PLIF组有1例出现症状学邻近节段退变,行二次手术治疗.结论 Dynesys动态内固定与融合术均获得良好临床疗效.与融合术相比,Dynesys动态内固定能够保留手术节段部分ROM,邻近节段椎间ROM的增幅及邻近节段退变发生数均较低.     

Dynesys系统结合PLIF在多节段腰椎退行性疾病的应用

目的:探讨Dynesys动态稳定系统联合腰椎后路椎间融合(PLIF)在腰椎多节段退变性疾病治疗中的临床疗效。方法:对2010年9月至2013年5月采用Dynesys动态稳定系统结合PLIF治疗的46例多节段腰椎退变性疾病患者进行回顾性分析,男17例,女29例;年龄38～68岁,平均(56.38±11.63)岁。手术节段:L₂-L₅ 16例(6例融合L_4,5,10例融合L_3,4、L_4,5);L₃-S₁ 30例(11例融合L₅S₁,19例融合L_4,5、L₅S₁).术后分别指术后3个月、术后1年和末次随访。分析内容包括:Oswestry功能障碍指数(ODI)、腰痛和腿痛的视觉模拟评分(VAS),并通过腰椎动力位X线观察节段活动度(ROM)、椎间隙高度(DHI)的变化情况。结果:术后随访时间16～48个月,平均(23.23±7.34)个月,术后3次随访腰痛、腿痛VAS 及ODI均较术前有明显降低 (p<0.01);融合节段椎间隙高度较术前明显增大(p<0.05),邻近非融合节段椎间隙高度与术前比较无明显变化(p>0.05);融合手术节段术后活动度均较术前显着减小(p<0.01),非融合的手术节段活动度均较术前减少(p<0.05).上邻近非融合手术节段活动度术前与术后3个月及术后1年比较差异无统计学意义(p>0.05),但与末次随访时比较时活动度增加(p<0.05).结论:Dynesys动态稳定系统结合PILF治疗腰椎多节段退行性疾病的近期疗效满意,可在融合、非融合中个体化选择。能够部分保留椎间活动度,预防邻近节段早期退变的发生,但长期临床疗效还需长时间临床观察。     

Short term outcome of posterior dynamic stabilization system in degenerative lumbar diseases

Background:

Decompression and fusion is considered as the ‘gold standard’ for the treatment of degenerative lumbar diseases, however, many disadvantages have been reported in several studies, recently like donor site pain, pseudoarthrosis, nonunion, screw loosening, instrumentation failure, infection, adjacent segment disease (ASDis) and degeneration. Dynamic neutralization system (Dynesys) avoids many of these disadvantages. This system is made up of pedicle screws, polyethylene terephthalate cords, and polycarbonate urethane spacers to stabilize the functional spinal unit and preserve the adjacent motion after surgeries. This was a retrospective cohort study to compare the effect of Dynesys for treating degenerative lumbar diseases with posterior lumbar interbody fusion (PLIF) based on short term followup.

Materials and Methods:

Seventy five consecutive patients of lumbar degenerative disease operated between October 2010 and November 2012 were studied with a minimum followup of 2 years. Patients were divided into two groups according to the different surgeries. 30 patients underwent decompression and implantation of Dynesys in two levels (n = 29) or three levels (n = 1) and 45 patients underwent PLIF in two levels (n = 39) or three levels (n = 6). Clinical and radiographic outcomes between two groups were reviewed.

Results:

Thirty patients (male:17, female:13) with a mean age of 55.96 ± 7.68 years were included in Dynesys group and the PLIF group included 45 patients (male:21, female:24) with a mean age of 54.69 ± 3.26 years. The average followup in Dynesys group and PLIF group was 2.22 ± 0.43 year (range 2-3.5 year) and 2.17 ± 0.76 year (range 2-3 year), respectively. Dynesys group showed a shorter operation time (141.06 ± 11.36 min vs. 176.98 ± 6.72 min, P < 0.001) and less intraoperative blood loss (386.76 ± 19.44 ml vs. 430.11 ± 24.72 ml, P < 0.001). For Dynesys group, visual analogue scale (VAS) for back and leg pain improved from 6.87 ± 0.80 to 2.92 ± 0.18 and 6.99 ± 0.81 to 3.25 ± 0.37, (both P < 0.001) and for PLIF, VAS for back and leg pain also improved significantly (6.97 ± 0.84–3.19 ± 0.19 and 7.26 ± 0.76–3.56 ± 0.38, both P < 0.001). Significant improvement was found at final followup in both groups in Oswestry disability index (ODI) score (both P < 0.001). Besides, Dynesys group showed a greater improvement in ODI and VAS back and leg pain scores compared with the PLIF group (P < 0.001, P = 0.009 and P = 0.031, respectively). For radiological, height of the operated level was found increased in both groups (both P < 0.001), but there was no difference between two groups (P = 0.93). For range of motion (ROM) of operated level, significant decrease was found in both groups (P < 0.001), but Dynesys showed a higher preservation of motion at the operative levels (P < 0.001). However, no significant difference was found in the percentage change of ROM of adjacent levels between Dynesys and PLIF (0.74 ± 8.92% vs. 0.92 ± 4.52%, P = 0.91). Some patients suffered from degeneration of adjacent intervertebral disc at final followup, but there was no significant difference in adjacent intervertebral disc degeneration between two groups (P = 0.71). Moreover, there were no differences in complications between Dynesys and PLIF (P = 0.90), although the incidence of complication in Dynesys was lower than PLIF (16.67% vs. 17.78%).

Conclusion:

Dynamic stabilization system treating lumbar degenerative disease showed clinical benefits with motion preservation of the operated segments, but does not have the significant advantage on motion preservation at adjacent segments, to avoid the degeneration of adjacent intervertebral disk.     

退变性腰椎滑脱症的手术治疗

目的探讨采用后路腰椎椎管减压、钉棒内固定并椎间植骨融合术和后路腰椎减压并Dynesys系统内固定手术治疗退变性腰椎滑脱的效果。方法应用后路腰椎椎间融合（posterior lumbar interbody fusion,PLIF）术进行椎管减压、钉棒系统固定并椎体间植骨融合手术治疗退变性腰椎滑脱37例;应用后路腰椎管减压并Dynesys内固定手术治疗退变性腰椎滑脱5例。结果随访9～39个月,平均26个月,腰痛疼痛视觉模拟量表（visual analogue scale,VAS）评分术前为8.7分,随访时为2.1分;腿痛VAS评分术前为7.6分,随访时为2.3分。术前Oswestry功能障碍指数（Oswestry disability index,ODI）为58.2%,随访时为21.2%。无严重手术并发症发生。术后X线片复查显示椎间高度均得到不同程度的恢复,滑脱椎体完全复位或者基本复位,椎间植骨融合。无融合器移位或螺钉松动、断裂。结论后路腰椎椎管减压、钉棒内固定并椎间植骨融合术和后路腰椎减压并Dynesys内固定手术治疗退变性腰椎滑脱效果满意,安全彻底的神经根管减压是取得满意临床效果的关键。     

Short-term effects of a dynamic neutralization system (Dynesys) for multi-segmental lumbar disc herniation

Purpose

To determine the safety and short-term curative effects of internal fixation using a dynamic neutralization system (Dynesys) for multi-segmental lumbar disc herniation (ms-LDH) with the control group treated by posterior lumbar interbody fusion (PLIF).

Methods

Forty-five patients with ms-LDH were selected as study group treated with Dynesys and 40 patients as control group with PLIF. The surgical efficacy was evaluated by comparing the visual analogue scale (VAS) scores, the Oswestry Disability Index (ODI) scores and the ROMs of the adjacent segment before and after surgery. The postoperative complications related to the implants were identified.

Results

All patients were followed up for an average duration of over 30 months. Dynesys stabilization resulted in significantly higher preservation of motion at the index level (p < 0.001), and significantly less (p < 0.05) hypermobility at the adjacent segments. VAS for back and leg pain and ODI improved significantly (p < 0.05) with both the methods, but there was no significant difference between the groups.

Conclusions

The non-fusion fixation system Dynesys is safe and effective regarding short-term curative effects for the treatment of ms-LDH.

     

Can formetric 4D measurements predict the development of adjacent segment degeneration after single-segment PLIF?: Relative rotation angle as a sensitive predictor

BackgroundAdjacent segment degeneration (ASD) is a major issue after posterior lumbar interbody fusion (PLIF). The postoperative dynamic change of adjacent segments remains unknown. Hence, this study using the formetric 4D system (DIERS, International GmbH of Schlangenbad, Germany) to determine the impact of PLIF on ASD, and to compare the effectiveness with traditional radiography for the predication of ASD.MethodsEighty-five consecutive patients who underwent PLIF of a single-segment were included. The formetric 4D system was used to calculate the relative rotation angle between the fusion segment and the upper and lower adjacent vertebrae before and at 6, 12 and 24 months after surgery. The range of motion (ROM) and disc height (DH) of adjacent segments were measured using radiography before surgery and 24 months postoperatively. At the final follow-up, the visual analogue scale (VAS) and Oswestry disability index were used to evaluate the surgical outcome. The patients were divided into two groups according to the occurrence of radiographic ASD: the ASD group with progression of degeneration and the N-ASD group without progression of degeneration.ResultsThe index fusion segments included L2-3 to L5-S1. Preoperatively, the relative rotation angles formed by the fusion segment with the upper and lower adjacent vertebrae were 5.1° ± 2.2° and 3.3° ± 2.0°, respectively, and both angles increased significantly at all time points after surgery (p < 0.05). The angles changed most significantly during L2-3 fusion. Radiographic ASD developed in 13 of 85 patients (15.3%) at 24 months. And the relative rotation angle with the upper adjacent vertebra was larger in the ASD group than in the N-ASD group (p < 0.05).ConclusionThe relative rotation angle with adjacent vertebra increased significantly after lumbar fusion surgery. It may be a more sensitive predictor than the flexion-extension ROM and DH for the development of radiographic ASD.     

腰椎后路椎间植骨融合内固定术后邻近节段椎间盘退行性改变生物力学特点的有限元分析

目的采用有限元方法分析腰椎后路椎间植骨融合内固定术后邻近节段椎间盘退变的生物力学特点。方法采集1名正常成人L_3~5的CT扫描数据,经有限元软件建立正常腰椎L_3~5模型(正常模型)、L_4、5椎弓根钉内固定模型(PSF),以及L_4、5全椎板减压、椎间cage融合、椎弓根钉内固定模型(PSF+PLIF)。比较3个模型在模拟人体腰椎前屈、后伸、左侧弯、右侧弯、左轴向旋转、右轴向旋转时L_3、4椎间盘膨出与内陷最大值,以及各方向L_3、4纤维环应力峰值。结果 PSF+PLIF模型与PSF模型L_3、4椎间盘膨出、内陷最大值较正常模型明显增大,且PSF+PLIF模型较PSF模型大,差异有统计学意义(P <0.05)。PSF+PLIF模型与PSF模型左侧弯、右侧弯、左轴向旋转、右轴向旋转时L_3、4的纤维环应力峰值增幅明显大于Model模型,且PSF+PLIF模型增幅大于PSF模型,差异有统计学意义(P <0.05)。结论腰椎后路椎间植骨融合内固定术引起邻近节段椎间盘生物力学改变是加重邻近节段椎间盘退行性改变程度的重要因素。     

退行性脊柱侧凸的手术治疗及相关文献回顾

目的　在回顾手术治疗退行性脊柱侧凸进展的基础上 ,探讨椎弓根螺钉系统在退行性脊柱侧凸矫治的策略 ,并评价其疗效。方法　 1999年 7月～ 2 0 0 2年 7月 ,本院骨科连续治疗 32例退行性脊柱侧凸患者 ,其中 7例先行一期前路脊柱松解 ,二期后路多节段椎弓根螺钉矫形 ,后外侧植骨融合 ;16例行后路椎管减压、PLIF椎体间支撑融合、椎弓根螺钉矫形内固定、后外侧植骨融合术 ;9例行后路椎管减压、椎板截骨短缩、椎弓根螺钉矫形内固定、后外侧植骨融合术。结果　本组围手术期没有出现切口感染 ,2例术后出现肺部感染症状 ,4例出现症状对侧的下肢痛 ,经过对症处理后好转。本组全部病例随访 18个月～ 3年 ,平均 2 .4年。全部病例无断钉、断棒 ,无交界性后凸。术前、术后及 18个月随访时进行Oswestry评分 ,统计结果表明术后和 18个月随访时ODS评分与术前有显著性差异 (P >0 .0 5 )。结论　在充分减压的前提下 ,椎弓根螺钉三维矫正技术对退行性脊柱侧凸可达到满意的纠正 ,重建脊柱稳定性 ,适当的前路松解和椎体间支撑性植骨有利于矢状面畸形的改善 ,减少神经并发症的发生