核心稳定性训练与植入物内固定腰椎融合修复退变性腰椎滑脱：腰椎功能评价

背景：腰椎退变性疾病是脊柱外科中的常见病、多发病，并且随着年龄的增加，发病率升高。 目的：通过对腰椎退变性疾病不同分期植入物内固定腰椎融合治疗及功能训练后脊柱稳定性分析，为提高临床治疗效果改善患者生活质量提供指导。 方法：①采用前瞻性随机对照设计，将52例Ⅰ度、Ⅱ度退变性腰椎滑脱患者随机分为训练组和对照组，每组26例。对照组给予传统训练，训练组给予核心稳定性训练，疗程24周。分别在治疗后6，12，24周进行数字疼痛评分和Oswestry功能障碍指数疗效评定。②通过数据库文献检索方法评估腰椎融合及植入物内固定修复退变性腰椎滑脱后的脊柱稳定性。 结果与结论：①治疗24周后，训练组的数字疼痛评分和Oswestry功能障碍指数均明显低于对照组(P < 0.05或P < 0.01)。核心稳定性训练对腰椎滑脱患者疼痛的缓解和恢复机体活动能力有显著效果。核心稳定性训练对退变性腰椎滑脱所致的慢性腰痛及功能改善优于传统的功能训练。②椎弓根固定并后外侧融合与后侧椎体间融合都可有效治疗Ⅱ度以内腰椎滑脱，后侧椎体间融合能更好的维持滑脱矫形及结构的稳定，后外侧融合后期易出现矫正丢失及内固定失败等问题，但临床疗效不受明显影响。中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Core stabilization exercises,implant fixation and lumbar fusion for degenerative lumbar spondylolisthesis: lumbar function evaluation

BACKGROUND:Lumbar degenerative disease is a common and frequently occurring disease in spinal surgery. With increasing age, the incidence rate is increased. OBJECTIVE:To elevate clinical outcomes and improve the quality of life of patients by analyzing spinal stability after lumbar implant fixation fusion and functional training in treatment of lumbar degenerative disease.  METHODS:(1) We used a prospective randomized controlled design. The 52 patients with I° or II° degenerative lumbar spondylolisthesis were randomly divided into two groups, with 26 cases in each group. Conventional exercises were carried out in the control group and core stabilization exercises for the treatment group, with course of treatment for 24 weeks. Curative effects of numerical rating scale and the Oswestry Disability Index were compared at 6, 12 and 24 weeks after treatment respectively. (2) Spinal stability after lumbar fusion and fixation of the implant for degenerative lumbar spondylolisthesis was evaluated by database document retrieval. RESULTS AND CONCLUSION:(1) After 24 weeks, numerical rating scale score and the Oswestry Disability Index were significantly lower in the treatment group than in the control group (P < 0.05 or P < 0.01). Core stabilization exercises apparently relieve lumbar pain and improve the ability of activities. Core stabilization exercises are better than conventional training. (2) Pedicle instrument fixation combined with interbody fusion is effective for lumbar spondylolisthesis within the second degree. Posterior interbody fusion has predominant mechanical property in maintaining spondylolisthesis orthopedic and stabilizing the structure. Correction loss and  fixation failure easily occur after posterolateral fusion, but clinical effects are not affected.