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Effectiveness of discectomy combined with IsobarPg 229 34[PMIDX21427858]

中国修复重建外科杂志2011年2月第25卷第2期·229·

髓核摘除联合Isobar非融合内固定治疗

腰椎间盘突出症

刘明1勘武生1李鹏1何大为2

【摘 要】目的评价髓核摘除联合Isobar非融合内固定治疗腰椎间盘突出症的近期疗效。 方法 2006年

5月-2008年5月,对65例单间隙腰椎间盘突出症患者分别采用髓核摘除联合Isobar非融合内固定(A组,34例)和单

独髓核摘除(B组,31例)治疗。A组男18例,女16例;年龄23~51岁,平均38.8岁。责任节段:L2、3 1例,L3、4 4例,L4、5 20例,L5、S1 9例。分型:突出型11例,脱出型16例,游离型7例。病程1~66个月,平均7.2个月。B组男19例,女12例;年龄21~49岁,平均39.2岁。责任节段:L3、4 2例,L4、5 24例,L5、S1 5例。分型:突出型13例,脱出型15例,游离型3例。病程3周~72个月,平均6.5个月。两组患者一般资料比较差异无统计学意义(P > 0.05),有可比性。手术

前后采用疼痛视觉模拟评分(V AS)及Oswestry功能障碍指数(ODI)进行比较评价,并动态观察术后责任椎间隙高度变

化情况。 结果两组患者均获随访,随访时间24~49个月,平均32个月。术后A、B组患者腰、腿痛症状均明显改善,

B组1例发生术后脑脊液漏,经处理后治愈。随访期间两组均无内固定物松动、断裂等并发症发生。A、B组术后3周、3、6个月和1、2年腰、腿痛V AS均较术前显著改善(P < 0.05);术后1、2年,A、B组间腰痛V AS比较差异有统计学意义(P < 0.05),其余各时间点腰痛V AS及手术前后各时间点腿痛V AS A、B组间比较差异均无统计学意义(P > 0.05)。术后2年

两组ODI与术前比较差异均有统计学意义(P < 0.05),但A、B组间比较差异无统计学意义(P > 0.05)。术后各时间点A

组责任椎间隙高度均较术前增加(P < 0.05);B组较术前下降,术后3周及3个月与术前比较差异无统计学意义(P > 0.05),术后6个月、1年及2年与术前比较差异有统计学意义(P < 0.05)。A、B组间术后各时间点责任椎间隙高度比较差异均

有统计学意义(P < 0.05)。 结论髓核摘除联合Isobar非融合内固定治疗节段隙腰椎间盘突出症的近期疗效满意,患

者术后腰痛缓解程度较单独髓核摘除术更明显,可能与其能维持术后责任椎间隙高度有关。

【关键词】腰椎间盘突出症髓核摘除非融合内固定

EFFECTIVENESS OF DISCECTOMY COMBINED WITH Isobar NON-FUSION INTERNAL FIXATION IN TREATING LUMBAR DISC PROTRUSION/LIU Ming1, KAN Wusheng1, LI Peng1, HE Dawei2. 1Department of Spine Surgery, Affi liated Puai Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan Hubei, 430033, P.R.China; 2Department

of Orthopaedics, Shanghai Changhai Hospital. Corresponding author: HE Dawei, E-mail: hedawei2000@http://www.doczj.com/doc/723cb7e719e8b8f67c1cb9c3.html 【Abstract】Objective To evaluate the short-term results of discectomy combined with Isobar non-fusion internal fixation. Methods Between May 2006 and May 2008, 65 cases of single segment lumbar disc protrusion were random surgically treated by discectomy combined with Isobar non-fusion internal fi xation (34 cases, group A) and single discectomy (31 cases, group B), respectively. In group A, there were 18 males and 16 females with an average age of 38.8 years (range, 23-51 years); the involved segments were L2,3 (1 case), L3,4 (4 cases), L4,5 (20 cases), and L5, S1 (9 cases), including 11 cases of protrusion type, 16 cases of prolapsed-type, and 7 cases of sequestered type; and the mean disease duration was 7.2 months (range, 1-66 months). In group B, there were 19 males and 12 females with an average age of 39.2 years (range, 21-49 years); the involved segments were L3,4 (2 cases), L4,5 (24 cases), and L5, S1 (5 cases), including 13 cases of protrusion type, 15 cases of prolapsed-type, and 3 cases of sequestered type; and the mean disease duration was 6.5 months (range, 3 weeks to 72 months). There was no signifi cant difference in the general data between 2 groups (P > 0.05). The surgical results were assessed by visual analogue scale (V AS) for back/leg pain and the Oswestry disability index (ODI). The height of involved intervertebral space was measured dynamically after operation. Results The patients of two groups were followed up 32 months on average (range, 24-49 months). All clinical symptoms of the patients were notably improved in 2 groups. One patient in group B experienced postoperative cerebral fl uid leakage, and was cured after extubation, changing posture, and other measures. There was no implant failure, such as pedicle fracture, screw loosening, or screw malposition during the follow-up. The ODI and V AS w
ere signifi cantly improved after operation. The back and leg pain V AS scores at each time point were decreased signifi cantly when compared with

of Orthopaedics, Shanghai Changhai Hospital. Corresponding author: HE Dawei, E-mail: hedawei2000@http://www.doczj.com/doc/723cb7e719e8b8f67c1cb9c3.html 【Abstract】Objective To evaluate the short-term results of discectomy combined with Isobar non-fusion internal fixation. Methods Between May 2006 and May 2008, 65 cases of single segment lumbar disc protrusion were random surgically treated by discectomy combined with Isobar non-fusion internal fi xation (34 cases, group A) and single discectomy (31 cases, group B), respectively. In group A, there were 18 males and 16 females with an average age of 38.8 years (range, 23-51 years); the involved segments were L2,3 (1 case), L3,4 (4 cases), L4,5 (20 cases), and L5, S1 (9 cases), including 11 cases of protrusion type, 16 cases of prolapsed-type, and 7 cases of sequestered type; and the mean disease duration was 7.2 months (range, 1-66 months). In group B, there were 19 males and 12 females with an average age of 39.2 years (range, 21-49 years); the involved segments were L3,4 (2 cases), L4,5 (24 cases), and L5, S1 (5 cases), including 13 cases of protrusion type, 15 cases of prolapsed-type, and 3 cases of sequestered type; and the mean disease duration was 6.5 months (range, 3 weeks to 72 months). There was no signifi cant difference in the general data between 2 groups (P > 0.05). The surgical results were assessed by visual analogue scale (V AS) for back/leg pain and the Oswestry disability index (ODI). The height of involved intervertebral space was measured dynamically after operation. Results The patients of two groups were followed up 32 months on average (range, 24-49 months). All clinical symptoms of the patients were notably improved in 2 groups. One patient in group B experienced postoperative cerebral fl uid leakage, and was cured after extubation, changing posture, and other measures. There was no implant failure, such as pedicle fracture, screw loosening, or screw malposition during the follow-up. The ODI and V AS were signifi cantly improved after operation. The back and leg pain V AS scores at each time point were decreased signifi cantly when compared with

作者单位:1 华中科技大学同济医学院附属普爱医院脊柱外科(武汉,430033);2 上海长海医院骨科

通讯作者:何大为,副主任医师,硕士生导师,研究方向:脊柱外科,E-mail: hedawei2000@http://www.doczj.com/doc/723cb7e719e8b8f67c1cb9c3.html

网络出版时间:2011-1-6 16:22:41;网络出版地址:http://www.doczj.com/doc/723cb7e719e8b8f67c1cb9c3.html /kcms/detail/51.1372.R.20110106.1622.201102.92_020.html