Clinical and radiographic results of cervical artificial disc arthroplasty: over three years follow-up cohort study

Background Theoretic advantages of cervical disc arthroplasty include preservation of normal motion and biomechanics in the cervical spine, and reduction of adjacent-segment degeneration. The clinical and radiographic effects of cervical disc arthroplasty in short term have been ascertained. The aim of this study is to research the data of mid-term results.Methods In this prospective cohort study, 50 patients who underwent cervical disc arthroplasty from December 2003 to January 2006 were enrolled. There were 39 patients who received 1-level disc arthroplasty, and 11 patients received 2-level disc arthroplasty, with an average age of 50.9 years （range from 29 to 73）. The median follow-up was 41.85months （range from 36.00-55.63 months）. Patients were followed prospectively with respect to their symptoms,neurologic signs, and radiographic results.Results The median value of Japanese Orthopaedic Association （JOA） score was 14.0 before surgery, and 16.5 at the most recent follow-up （P 〈0.01）. The median value of the recovery rate of the JOA score was 92.2%. The preoperative range of motion （ROM） at the indexed level was （10.40±4.97）°, which has significantly correlated with the most recent follow-up ROM which was （8.56±4.76）° （P 〈0.05, r=0.33）. The ROM at the operative level at the most recent follow-upwas greater than the value at the 3-month follow-up of （7.52±3.37）° （P 〈0.05）. The preoperative functional spinal unit （FSU） angulation was （-0.96±6.52）°, which was not significantly correlated with that of the most recent follow-up value of （-2.65±7.95）° （P 〈0.01, r=0.53）. The preoperative endplate angulation was （2.61±4.85）°, which had no significant correlation with that of the most recent follow-up value of （0.71±6.41）° （p 〉0.05）.Conclusions The clinical and radiographic results of cervical disc arthroplasty are good in mid-term follow-up. The normal range of motion of the operated level and the biomechanics in the cervical spine are well preserved.     

Application of cervical arthroplasty with Bryan cervical disc: long-term X-ray and magnetic resonance imaging follow-up results

Background Cervical disc arthroplasty is a new technique for treating degenerative cervical disease. Its goal is to avoid the degeneration of adjacent levels by preserving motion at the treated level. The aims of this study were to evaluate the radiologic outcomes of Bryan cervical disc replacement and the degenerative status of adjacent segments.Methods Twenty-two patients at a single center underwent discectomy and implantation of Bryan cervical disc. The mean follow-up period was 60 months （57-69 months）. Twenty patients underwent single-level arthroplasty and two underwent arthroplasty at two levels. The levels of surgery included C3/4 （3 levels）, C4/5 （2 levels）, C5/6 （18 levels） and C6/7 （1 level）. Radiographic evaluation included dynamic X-ray examination and magnetic resonance imaging （MRI） at baseline and at final follow-up.Results On X-ray examination, the range of motion （ROM） at the operated level was 7.2° （2.5°-13.0°） at baseline and 7.8° （1.0°-15.0°） at final follow-up （P 〉0.05）. Heterotopic ossification around the prosthesis was observed in eight levels,and two levels showed loss of motion （ROM 〈2°）. MRI showed worsening by a grade at the upper level in 2/22 patients,and worsening by a grade at the lower level in 3/22, according to Miyazaki＇s classification. No further impingement of the ligamentum flavum into the spinal canal was observed at adjacent levels, though the disc bulge was slightly increased at both the adjacent upper and lower levels at final follow-up.Conclusions Arthroplasty using Bryan cervical disc prosthesis resulted in favorable radiologic outcomes in this study.Disc degeneration at adjacent levels may be postponed by this technique.     

COA：Bryan人工颈椎间盘置换术后长期的X线和MRI随访研究

目的：观察Bryan人工颈椎间盘置换术后长期的影像学随访结果和相邻节段退变情况。方法：对比分析术前和末次随访时动力位Ｘ线片和MRI,观察置换节段活动度和相邻节段退变分级。结果：1）２２例患者获得５年的随访,随访时间５７－６９个月。其中２０例患者为单节段,２例患者为双节段人工间盘置换术。手术节段包括3例C34,2例C45,18例C56和1例C67。2）术前置换节段的活动度为7.2°(2.5-13.0°),末次随访时为 7.8°(1.0-15.0°),无统计学差异 (P>0.05)。8例节段出现异位骨化,其中2例节段活动度丧失（活动度<2°）3）根据Miyazaki颈椎椎间盘MRI退变分级方法对相邻节段进行退变分级,22例上相邻节段末次随访时MRI退变分级与术前相同。下相邻节段末次随访时有1例由3级发展到4级。结论：Bryan人工间盘置换术后置换节段活动度得到很好保留,相邻节段未出现明显加速退变的表现。     

Comparison of adjacent segment degeneration five years after single level cervical fusion and cervical arthroplasty: a retrospective controlled study

Background  Cervical arthroplasty is indicated to preserve cervical motion and prevent accelerated adjacent segment degeneration. Whether accelerated adjacent segment degeneration is prevented in the long term is unclear. This trial compared adjacent segment degeneration in Bryan disc arthroplasty with that in anterior cervical decompression and fusion five years after the surgery.

Methods  We studied patients with single level degenerative cervical disc disease. The extent of adjacent segment degeneration was estimated from lateral X-rays.

Results  Twenty-six patients underwent single level Bryan disc arthroplasty and twenty-four patients underwent single level anterior cervical decompression and fusion. All patients were followed up for an average of sixty months. In the Bryan arthroplasty group, nine (17.6%) segments developed adjacent segment degeneration, which was significantly lower than that (60.4%) in the anterior cervical decompression and fusion group. Eleven segments in the Bryan arthroplasty group developed heterotopic ossification according to McAfee’s classification and two segments had range of motion less than 2°. In the heterotopic ossification group, four (19.5%) segments developed adjacent segment degeneration, similar to the number in the non-heterotopic ossification group (16.7%). Adjacent segment degeneration rate was 50% in grade IV group but 11.8% in grade II to III.

Conclusions  Adjacent segment degeneration was accelerated after anterior cervical decompression and fusion. However, Bryan disc arthroplasty avoided accelerated adjacent segment degeneration by preserving motion. Patients with grade IV heterotopic ossification lost motion, and the rate of adjacent segment degeneration was higher than that in patients without heterotopic ossification.

     

Incidence and risk factors analysis of heterotopic ossification after cervical disc replacement

Background Cervical disc replacement （CDR） as a substitute for traditional fusion surgery has been widely used in treating degenerative cervical disc diseases.The objectives of this study were to assess the clinical and radiological findings for patients with heterotopic ossification （HO） following CDR and to detect the risk factors of HO after CDR.Methods A total of 125 patients with symptomatic cervical single-or double-level disc diseases,who underwent CDR procedure with Discover prosthesis in Department of Spine Surgery,Changzheng Orthopedics Hospital from March 2009 to March 2011,were enrolled in this retrospective study.Occurrence of HO was defined by the McAfee classification on cervical lateral X-rays in this study.Prosthesis vertebral ratio （PVR） was used to determine the matching degree between the cervical disc prosthesis and cervical vertebra.Logistic regression analyses were performed to determine the risk factors of HO.Variables evaluated for their association with HO occurrence included age,gender,high-intensity signal in spinal cord,preoperative range of motion （ROM）,postoperative ROM,operation level number,and PVR.Results Mean follow-up time was （26.4±5.8） months.All the patients had significant symptoms and neurological function improvements during the follow-up period.The ROM of the operated segment from the preoperative period to the last follow-up was relatively well maintained.The rate of HO in this cohort of patients,who underwent Discover disc,was 27.92％ per surgical level and 24.8％ per patient by the last follow-up.There were 19 patients （19.79％） with HO in the single-level group while 12 patients （41.38％） in the double-level group.Conclusions We identified preoperative high-intensity signal in spinal cord,postoperative ROM of surgical level,number of operation level,and PVR as significant risk factors for postoperative HO occurrence.     

Minimum 5-year follow-up study on the effects of the Wallis dynamic stabilization system in the treatment of lumbar degenerative disease

Background Short-term outcomes of the Wallis system in the treatment of lumbar degenerative disease （LDD） have been shown to be effective, whereas there is a paucity of studies on the mid-long-term effects of the treatment of the Wailis system. This study was to evaluate the mid-long-term effects of the Wallis dynamic stabilization system in the treatment of LDD. Methods A total of 26 patients who received the treatment of the Wallis system between February 2008 and January 2009 were included in the study, with 14 patients （Group 1） with L4/5 disc herniation and 12 patients （Group 2） with L5/S1 disc herniation and L4/5 intervertebral disc degeneration （IDD）. Visual analog scale （VAS） and Oswestry Disability Index （ODI） were used to evaluate the clinical outcomes and lumbar X-rays and MRI were obtained to observe imaging changes before and after operation. Results The mean follow-up period was （63.50＋2.12） months. The mean ODI and VAS scores decreased obviously three months and five years after operation （P 〈0.05）. In Groups 1 and 2, L4/5 Cobb angle and range of motion （ROM） decreased and L4/5 posterior disc height increased at the last follow-up （P 〈0.05）. There were no statistically significant changes in L4/5 anterior disc height and L3/4 University of California at Los Angeles grading before and after operation. There was no statistically significant change in Pfirrmann grading system of L4/5 IDD in Group 2 before and after operation. Adjacent segment degeneration at the last follow-up was found in two patients （2/26, 7.69%） and Modic changes in L4/5 endplates were detected in one patient （1/26, 3.85%）. Conclusions The mid-long-term effects of the Wallis system in the treatment of LDD were satisfied. The Wallis system, as a dynamic stabilization system, which can preserve some ROM of the fixed segment, sustain the lumbar stabilization, and prevent adjacent segment disease and fixed segment degeneration, is an effective instrument to treat LDD.     

颈前路减压植骨融合术与保守疗法治疗单节段颈椎间盘突出症的疗效评价

目的：对比研究采用颈前路减压植骨融合术与保守疗法治疗单节段颈椎间盘突出症的远期疗效,分析颈椎前路减压植骨融合术远期邻近节段间盘的退变程度。方法：选取2006年1月-2009年1月吉林省人民医院骨科收治的颈椎单节段病变患者120例,按患者意愿进行分组,其中手术组60例行颈前路植骨融合术,非手术组60例行保守治疗。2组患者发现病变时进行随访,在手术组患者发现病变后60个月及手术组患者术后60个月再次进行随访,对患者进行美国脊髓损伤协会（ASIA）评分、疼痛视觉模拟（VAS）评分、日本矫形外科协会（JOA）脊髓功能评分及影像学评估（Miyazaki分级）。结果：107例患者获得随访,55例手术组患者平均随访59.7个月,52例非手术组患者平均随访58.8个月。与治疗前比较,手术组患者治疗后ASIA、VAS和JOA评分均有改善,差异有统计学意义（P<0.05）;与非手术组比较,手术组患者ASIA、VAS和JOA评分差异也有统计学意义（P<0.05）。手术组患者相邻节段上一邻近节段间盘的退变发生率明显高于下一邻近节段（P<0.05）。结论：颈椎前路植骨融合术治疗单节段颈椎间盘突出症在缓解症状、改善预后方面优于保守疗法;颈椎前路单节段植骨融合术后远期间盘退变主要发生在上一邻近节段。     

颈椎前路减压融合与人工颈椎椎间盘置换联合对多节段颈椎病的疗效及邻近节段退变的影响分析

目的:探究颈椎前路减压融合术(anterior cervical decompression and fusion,ACDF)联合人工颈椎椎间盘置换术(artificial cervical disc replacement,ACDR)在治疗多节段颈椎病上的临床疗效及对其邻近节段退变的影响。方法:按入院先后将本院收治的57例多节段颈椎病患者分为观察组(32例)和对照组(25例)。对照组患者给予ACDF进行治疗;观察组患者则采用颈椎Hybrid手术方式(ACDF联合ACDR)进行治疗。就两组患者的临床治疗效果以及邻近节段退变情况进行对比性分析。结果:观察组患者的术中出血量、手术时间以及住院时间均明显低于对照组(P<0.05)。在两组患者的腰椎功能改善上,观察组的总有效率为90.63%,与对照组(92.00%)比较并未见明显差异(P<0.05)。在术前、术后3个月、术后6个月和术后12个月,两组患者在JOA评分以及NDI评分均未见显著差异(P>0.05)。术后12个月,观察组患者的颈椎整体活动度明显大于对照组,其上、下位邻近节段活动度则明显低于对照组(P<0.05)。结论:在治疗多节段颈椎病上,ACDF联合ACDR疗效显著,能够减少邻近节段运动的负荷,降低了邻近节段退变的发生,此外还具有创伤小、恢复快、并发症少的特点。     

Removal versus preservation of the posterior longitudinal ligament in Bryan cervical disc arthroplasty

Background Bryan cervical disc arthroplasty can be used to restore and maintain the mobility and function of the involved cervical spinal segments. The efficiency of posterior longitudinal ligament （PLL） resection in anterior cervical decompression and fusion has been demonstrated. However, no clinical reports have compared PLL removal with preservation in Bryan cervical disc arthroplasty. This study aimed to assess the role of removal of PLL in Bryan cervical disc arthroplasty at an 18-month follow-up.     

伴颈椎后纵韧带骨化的颈椎间盘突出症手术治疗分析

目的：探讨伴颈椎后纵韧带骨化的颈椎间盘突出症的手术治疗。方法：选取2011年1月至2012年1月期间在我院接受治疗的伴颈椎后纵韧带骨化的颈椎间盘突出症患者48例,分为实验组(24例)和对照组(24例),实验组成员行颈椎前路椎体次全切除+后纵韧带切除,对照组成员行颈椎后路单开门手术,且两组都加上颈椎间盘摘除,对比两组患者的手术效果。结果：实验组术后改善水平高于对照组,差异具有统计学意义(P<0.05)。结论：采用颈椎前路椎体次全切除+后纵韧带切除手术治疗伴颈椎后纵韧带骨化的颈椎间盘突出症患者疗效显著,此种方式在临床中值得推广。     

强直性脊柱炎伴髋关节屈曲挛缩畸形行非骨水泥型全髋关节置换术疗效分析

目的 探究强直性脊柱炎合并髋关节屈曲挛缩畸形患者行非骨水泥型全髋人工关节置换术的手术策略和临床疗效.方法 回顾2011年8月-2012年7月解放军总医院门诊收治入院的41例（82髋）临床确诊强直性脊柱炎合并髋关节屈曲挛缩畸形并行非骨水泥型全髋关节置换术的患者资料,平均随访时间24.6（21 ～ 32）个月.对比手术前后关节疼痛、关节畸形、活动度及关节功能改善状况,依据Harris评分评价髋关节术后功能状况.结果 术后髋关节屈曲挛缩畸形术前平均72.4°（64.8°～ 81.5°）,术后平均20.7°（8.6°～36.4°）（P＜0.01）;总活动度术前平均2.7°（0°～5.8°）,术后平均84.5°（78.7°～104.5°）（P＜0.01）;Harris评分术前平均25.7分,术后平均78.1分（P＜0.01）.末次随访（2014年4月18日）拍摄X线片,未见假体周围透亮区及关节脱位.结论 非骨水泥型全髋关节置换术是强直性脊柱炎合并髋关节屈曲挛缩畸形患者减轻疼痛并重建关节功能的有效方法.     

Bryan人工颈椎间盘置换术与颈前路减压植骨融合术的近期疗效随机对照研究

目的:分析对比Bryan人工颈椎间盘置换术与颈前路减压植骨融合术(AC-DF),探讨Bryan人工颈椎间盘置术后的近期疗效、植入节段的活动度、手术适应证以及早期并发症。方法:对2004年12月至2006年1月我科23例31个Bryan颈椎间盘置换术患者以及同期行颈前路减压植骨融合术42例55个节段患者进行随访,其中Bryan组随访时间为3～18月,平均12.1月,超过1年随访的有14例,6月以上随访的有21例;ACDF组随访时间全部超过1年以上。分别观察两组术中所用时间(分单、双节段)、术中出血量(分单、双节段)、术后颈部外固定以及住院时间与术后恢复工作时间;于术前、术后3d、3个月、6个月、12个月通过JOA评分、生命质量SF-36评分评定治疗效果。同期摄X线片,检测病变节段的椎间高度、颈椎前屈后伸与侧弯活动范围以及颈椎生理前凸改变情况。结果:Bryan组单、双节段置换术中平均手术时间、平均手术出血量与AC-DF组之间无显著性差异(P>0.05);而两组住院时间、术后颈部外固定时间以及术后恢复工作时间比较有显著性差异(P<0.01);术后12个月,Bryan组JOA评分从平均8.4增加到16.3,SF-36评分平均56分上升至88分,置换节段椎间高度恢复,这些与ACDF组比较无显著性差异(P>0.05);术后12个月,Bryan组的屈曲-后伸活动范围:单节段组平均为7.54°,双节段组平均为6.98°;左右侧屈活动范围分别为平均3.26°和3.08°,与ACDF组比较有显著性差异(P<0.01);Bryan组颈椎生理弧度由术后3d的平均12mm变小至术后12个月的平均9mm,有轻度的丢失;本组在随访期间未出现任何并发症。结论:Bryan人工颈椎间盘置换术近期疗效良好,安全可靠、病人恢复快且并发症少;其能更有效解除神经压迫、缓解症状,同时还保留颈椎病变节段活动度、防止邻近节段退变加速,其为治疗颈椎病提供了一种新的选择。     

腰椎融合辅以邻近节段动态固定与腰椎融合治疗腰椎退行性疾病早期疗效的对比观察

目的 对比评价单节段腰椎融合辅以邻近节段Isobar动态固定(邻近节段保护)与单节段椎间融合两种方式治疗腰椎退行性疾病的早期疗效及对邻近节段运动功能的影响,探讨采用Isobar动态固定进行邻近节段保护的应用价值.方法 回顾性分析2008年10月至201 1年1月椎间融合辅以邻近节段Isobar动态固定及单节段椎间融合内固定术的57例患者资料.邻近节段保护组27例患者术前邻近节段退变较重,行单节段融合辅以邻近节段Isobar动态固定;单节段融合组30例患者术前邻近节段无不稳或退变较轻,行单节段椎间融合内固定术.对比评价两组腰腿痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(oswestry disability index,ODI)、腰椎总活动度及邻近节段活动度(range of motion,ROM)、保护节段及邻近节段退变(adjacent segment degeneration,ASDeg)发生率.结果 随访时间12～40个月.两组患者术后VAS及ODI评分均获得显著改善,且两组间差异无统计学意义(P＞0.05).末次随访时两组间腰椎总活动度差异无统计学意义(P＞0.05).邻近节段保护组保护节段末次随访时椎间隙高度与术前无差异.两组术后头侧第一邻近节段活动度均显著增加.至末次随访时,邻近节段保护组保护节段退变均未见进展,邻近节段保护组7例、单节段融合组5例出现邻近节段不稳,两组之间差异无统计学意义(P=0.30).邻近节段保护组出现螺钉松动及断裂各1例.结论 腰椎融合辅以邻近节段动态固定治疗腰椎退行性疾病具有良好的早期疗效,其远期疗效有待长期随访观察.该技术存在动态固定失效的风险,其发生可能与操作技术及适应证选择有关,故应严格掌握其手术适应证,以术前邻近节段存在明显退变或不稳且无骨质疏松症的患者为宜.     

显微镜下蛛网膜下腔减压、灌洗术治疗脊髓型颈椎临近节段退变病的临床疗效分析

目的：探讨显微镜下蛛网膜下腔减压、灌洗术治疗脊髓型颈椎临近节段退变病的临床疗效。方法：2012年9月—2015年9月,23例脊髓型颈椎临近节段退变病的患者行显微镜下蛛网膜下腔减压、灌洗术,术后3个月、6个月、2年规律随访,随访时复查颈椎正侧位平片、颈椎CT、MRI,并采用日本骨科协会（JOA）评分评价颈髓功能。结果：23例患者平均获随访至术后2年,所有病例在术中术后均未出现严重并发症,术后症状缓解满意,术后随访各时间点未见内固定失效、骨性椎管再狭窄,术后3个月MRI见脊髓T2W高信号改变较术前明显减轻,术后6个月MRI见脊髓T2W高信号改变较术后3个月减轻、术后2年MRI检查见脊髓T2W高信号改变基本消失;术前JOA评分（7.67 ± 1.16）分,术后3个月、6个月、2年的JOA评分分别为（10.87 ± 0.82）分、（13.09 ± 0.73）分、（13.48 ± 0.67）分,JOA评分改善率分别为（34.91 ± 8.64）%、（58.55 ± 7.40）%、（62.70 ± 6.46）%;术后JOA评分均高于术前（P＜0.05）;术后6个月、术后2年JOA评分均高于术后3个月（P＜0.05）;术后2年JOA评分与术后6个月差异无统计学意义。结论：显微镜下蛛网膜下腔减压、灌洗术治疗脊髓型颈椎临近节段退变病可获得满意的临床疗效。疗效主要与显微镜下松解脊髓各被膜间的粘连、解除硬脊膜内外的压迫及灌洗降低部位炎症因子水平相关。     

微波组织凝固治疗宫颈肌瘤5年随访报告

目的探讨微波组织凝固治疗宫颈肌瘤的中远期疗效及并发症。方法对78例不同类型的宫颈肌瘤患者用微波手术器行组织凝固治疗并随访,有完整随访5年的资料48例,观察局部愈合、临床症状改善及复发等情况。结果78例宫颈肌瘤,术后2周复查,痊愈35例,其中带蒂肌瘤28例;3周复查痊愈29例;4周后痊愈14例。有6例在术后2周有局部出血并予三氯化铁局部烧灼止血。术后6个月观察宫颈形状恢复正常,原瘤床处不留疤痕,临床症状消失。48例随访5年的患者术后2周痊愈19例;3周痊愈21例;4周后痊愈8例。短期随访全部病例均一次治疗成功,症状消失。5年时36例临床症状与体征与短期效果相当,9例宫颈有影像学肌瘤复发,但无临床症状及体征,3例体检可见宫颈肌瘤并活检证实,且伴有临床症状。结论微波组织凝固治疗宫颈肌瘤短期效果好,患者容易接受,几乎无并发症,但长期有一定复发,可能与肌瘤生长的位置、手术操作、组织凝固的范围等因素有关,也不排除新生肌瘤的可能。     

手术治疗退变性腰椎侧凸5年以上随访研究

目的：评价手术治疗退变性腰椎侧凸的临床效果及再次手术的危险因素和疗效。方法：回顾性分析2003年6月至2008年6月在北京大学第一医院骨科诊断为退变性腰椎侧凸并接受椎管减压、腰椎内固定手术的47例患者的完整病例资料,应用日本骨科协会评分（Japanese Orthopedic Association,JOA）和视觉模拟评分法（visual analogue score,VAS）评价其术后临床症状改善情况,并记录患者的再次手术原因和术后效果。结果：所有患者均完成随访,平均随访时间为（8.2±3.6）年（5.2~12.5年）,平均年龄（67.0±9.6）岁（56~81岁）。随访过程中有10例行再次翻修手术,其中固定节段近端失败8例、远端失败2例。37例首次手术后5年的平均临床改善优良率为83.3%,10例再次翻修术后1年平均临床改善优良率为67.6%。结论：手术治疗退变性腰椎侧凸随访5年以上具有较好的临床效果,但存在一定比例的再手术率,再次翻修手术的临床效果有所下降,患者低骨量、近端融合至L1及远端融合至S1可能是导致再次手术的危险因素。     

椎间盘退变相关基因单核苷酸多态性的研究进展

椎间盘退变具有一定程度的遗传易感性,可能与人群中存在基因多态性有关。近年来,椎间盘退变与基因单核苷酸多态性的相关性研究逐渐增加并取得长足进展,目前研究的基因主要包括3类:(1)与椎间盘稳定性相关的基因,包括结构相关基因和代谢相关基因;(2)炎症相关基因;(3)疼痛信号通路相关基因。研究椎间盘退变相关基因单核苷酸多态性将有助于揭示椎间盘退变的遗传学机制,从而为个性化预防和治疗椎间盘退变疾病开辟新的道路。     

腰椎间盘突出伴马尾神经综合征患者延迟手术减压的长期随访分析

目的 分析腰椎间盘突出伴马尾神经综合征患者接受延迟手术减压后神经系统及排尿功能恢复的长期随访结果.方法 将35例符合腰椎间盘突出伴马尾神经综合征患者纳入此次随访,着重关注患者术前及术后的膀胱排空功能、排便功能、性功能、鞍区感觉及下肢神经功能恢复情况;6例患者术前术后均接受尿动力学检查.结果 35例患者中,12例完全性马尾神经综合征患者平均延迟手术减压时间为4.1+3.9周,23例不完全性马尾神经综合征患者平均延迟减压时间为5.5+7.6周;所有患者随访3～110月(平均43.0+28.9月).23例不完全性马尾神经综合征患者中,19例完全恢复,4例存在轻微的鞍区或下肢感觉功能改变;12例完全性马尾神经综合征患者中,2例患者完全恢复,4例患者存在轻微鞍区或下肢感觉障碍且其中2例存在偶发便秘,其余6例患者存在不同程度的鞍区感觉障碍、排尿及排便功能障碍.6例有完整术前及术后尿动力学结果的患者中,随访尿动力学检查提示排尿时腹压明显上升,残余尿量较术前明显减少,其中4例患者初次排尿感觉时膀胱容量恢复正常.结论 对接受延迟手术的腰椎间盘突出伴马尾神经综合征患者,长期随访结果显示多数患者预后良好,神经功能均有不同程度恢复.尿动力学检查提示膀胱排空功能恢复可能为膀胱感觉恢复引发的排尿时腹内压代偿升高所致.膀胱功能恢复的关键策略为促进膀胱逼尿肌收缩功能的恢复.     

Dynesys动态固定系统用于腰椎多节段退行性疾病的2年随访临床疗效观察

目的 通过对比分析评估Dynesys动态固定系统与融合术在腰椎多节段退行性疾病治疗中的临床疗效及对腰椎运动功能的影响.方法 收集2013年1月至2014年5月在我院行多节段Dynesys动态固定及融合术的51例患者的临床资料,其中Dynesys动态固定组24例,融合组27例.应用腰椎疼痛视觉模拟指数评分(visual analogue scale,VAS)、腰椎功能评分(oswestry disability index,ODI)评估临床疗效;对比分析两种术式术前及术后6、12、24个月腰椎整体活动度、手术节段活动度、邻近第一椎间活动度、邻近第一椎间高度、邻椎病(adjacent segment disease,ASD)的发生率,评估两种术式对腰椎运动功能的影响.结果 51例患者均获得完整随访,平均随访26.2(23~31)个月.两组病例VAS评分及ODI评分术后各时间点与术前相比均明显下降,差异有统计学意义(P<0.05),术后6个月组间比较差异有统计学意义(P<0.05),其余各时间点组间比较差异无统计学意义.Dynesys动态固定组术后较融合组保留了更多的腰椎整体活动度,差异有统计学意义(P<0.01).Dynesys动态固定组术后保留了部分手术节段的活动度,融合组因融合而丢失活动度,组间比较差异有统计学意义(P<0.01).术后24个月两组病例邻近上一椎间活动度差异有统计学意义(P<0.01),邻近上一椎间高度组间及组内各时间点比较差异无统计学意义.在ASD方面,融合组3例出现邻近节段不稳,但无明显临床症状,未行临床干预.结论 Dynesys动态固定系统治疗腰椎多节段退行性疾病具有良好的临床疗效,同时保留了更多的活动度,减缓ASD的发生,可以作为一种较好的手术治疗选择.     

Intervertebral disc degeneration and bone density in degenerative lumbar scoliosis: a comparative study between patients with degenerative lumbar scoliosis and patients with lumbar stenosis

Background  Degenerative lumbar scoliosis is common in older patients. Decreased bone density and the degeneration of intervertebral discs are considered to be correlated with degenerative lumbar scoliosis. A means of quantifying the relative signal intensity for degenerative disc disease has not been previously discussed. The purpose of this study was to compare bone mineral density and intervertebral disc degeneration between degenerative lumbar scoliosis and lumbar spinal stenosis patients in a nine-year retrospective study.

Methods  From January 2001 to August 2010, 96 patients with degenerative lumbar scoliosis were retrospectively enrolled and 96 patients with lumbar spinal stenosis were selected as controls. Cobb angle, height of the apical disc and the contiguous disc superiorly and inferiorly on convex and concave sides, the height of the convex and concave side of the apical and the contiguous vertebral body superiorly and inferiorly were measured in the scoliosis group. The height of L2/L3, L3/L4, L4/L5 discs and the height of L2/L4 vertebral body was measured in the control group. The grade of intervertebral disc degeneration was evaluated using T2WI sagittal images in both groups. The bone density of lumbar vertebrae was measured with dual-energy X-ray.

Results  In scoliosis group, the intervertebral disc height on the convex side was greater than the height on the concave side (P <0.001). The vertebral body height on the convex side was greater than the height on the concave side (P=0.016). There was a significant difference between the scoliosis group and the control group (P=0.003), and between T-value and the rate of osteoporosis between the two groups (both P <0.001). Results were verified using multiple linear regression analysis.

Conclusions  Degenerative lumbar scoliosis is accompanied by height asymmetry between the intervertebral disc and vertebral body regarding the convex and concave surfaces. There is a positive correlation between the angle of scoliosis and the disc index, the degree of degeneration of the intervertebral disc, and a negative correlation between the angle of scoliosis and bone density.