ISOBAR TTL半坚强后路动态内固定系统治疗腰椎退行性疾病疗效观察

目的探讨ISOBAR TTL半坚强后路动态内固定系统(简称ISOBAR TTL系统)治疗腰椎退行性疾病的近期疗效。方法 2007年6月-2011年5月,收治38例腰椎退行性疾病患者。男24例,女14例;年龄21～67岁,平均51.2岁。病程8个月～10年,平均4.7年。病变节段为L4～S1。其中腰椎退变性Ⅰ度滑脱4例,腰椎不稳并椎间盘突出11例,退行性腰椎管狭窄、椎间盘突出21例,L4、5椎间盘突出症术后复发2例。合并邻近节段椎间盘变性退变22例。患者均行后路减压,ISOBAR TTL系统固定;双节段固定者同时行椎间融合。采用疼痛视觉模拟评分(VAS)及日本骨科协会(JOA)评分行下腰痛评价,测量半坚强动态固定节段活动度。结果术后1例切口延期愈合,余切口均Ⅰ期愈合,38例均获随访,随访时间8～53个月,平均27.8个月。术后ISOBAR TTL系统固定可靠,无松动、断裂、后凸畸形;无邻近节段退变发生。动态固定节段活动度:0～1°3例,1～2°4例,2～3°14例,3～4°15例,>4°2例。末次随访时VAS评分为(1.93±2.43)分,较术前(8.20±1.78)分显著降低(t=7.761,P=0.000);下腰痛JOA评分为(23.06±7.75)分,较术前(4.87±3.44)分显著增加(t=10.045,P=0.000)。采用Stauffer-Coventry标准评定疗效,获优32例,良3例,中2例,差1例,优良率为92.1%。结论 ISOBAR TTL系统治疗腰椎退行性疾病近期疗效较好。

EFFECTIVENESS OF ISOBAR TTL SEMI-RIGID DYNAMIC STABILIZATION SYSTEM IN TREATMENT OF LUMBAR DEGENERATIVE DISEASE

Objective To investigate the short-term effectiveness of ISOBAR TTL semi-rigid dynamic stabilizationsystem(ISOBAR TTL system) in treatment of lumbar degenerative disease.Methods Between June 2007 and May 2011,38 cases of lumbar degenerative disease were treated,including 24 males and 14 females with an average age of 51.2 years(range,21-67 years).The disease duration was 8 months to 10 years(mean,4.7 years).In 38 cases,there were 4 cases of gradeI spondylolisthesis,11 cases of lumbar instability and lumbar disc protrusion,21 cases of lumbar spinal stenosis and lumbardisc protrusion,and 2 cases of postoperative recurrence of lumbar disc protrusion.There were 22 cases of adjacent segment discdegeneration.All cases underwent posterior decompression and implantation of ISOBAR TTL system.The double-segmentfixed patients underwent interbody fusion.Visual analogue scale(VAS) and Japanese Orthopaedic Association(JOA) scoresfor low back pain were used to evaluate clinical outcomes.The range of motion(ROM) at the semi-rigid dynamic stabilizationsegment was also measured.Results The other cases achieved healing of incision by first intention,except 1 case of delayedhealing.All the patients were followed up 8-53 months(mean,27.8 months).After operation,ISOBAR TTL system showedreliable fixation,and no loosening,breakage,or kyphosis deformity occurred.No adjacent segment degeneration was observed.The ROM of the fixed segments was 0-1° in 3 cases,1-2° in 4 cases,2-3° in 14 cases,3-4° in 15 cases,and > 4° in 2 cases.At lastfollow-up,the VAS score was 1.93 ± 2.43,and was significantly lower than preoperative score(8.20 ± 1.78)(t=7.761,P=0.000).JOA score was 23.06 ± 7.75,and was significantly higher than preoperative score(4.87 ± 3.44)(t=10.045,P=0.000).According toStauff er-Coventry evaluation standard,the results were excellent in 32 cases,good in 3 cases,fair in 2 cases,and poor in 1 case,with an excellent and good rate of 92.1%.Conclusion Good short-term effectiveness can be achieved by surgical interventionwith ISOBAR TTL system in treatment of lumbar degenerative disease.