張力 1 , 舒小秋 1 , 段揚 1 , 葉剛 2 , 靳安民 1
  • 南方醫(yī)科大學珠江醫(yī)院（廣州，510282）1 骨科，2 放射科;

目的 探討ISOBAR TTL半堅強后路動態(tài)內(nèi)固定系統(tǒng)（簡稱ISOBAR TTL系統(tǒng)）治療腰椎退行性疾病的近期療效。 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；年齡21～67歲，平均51.2歲。病程8個月～10年，平均4.7年。病變節(jié)段為L4～S1。其中腰椎退變性Ⅰ度滑脫4例，腰椎不穩(wěn)并椎間盤突出11例，退行性腰椎管狹窄、椎間盤突出21例，L4、 5椎間盤突出癥術(shù)后復發(fā)2例。合并鄰近節(jié)段椎間盤變性退變22例?；颊呔泻舐窚p壓，ISOBAR TTL系統(tǒng)固定；雙節(jié)段固定者同時行椎間融合。采用疼痛視覺模擬評分（VAS）及日本骨科協(xié)會（JOA）評分行下腰痛評價，測量半堅強動態(tài)固定節(jié)段活動度。 結(jié)果術(shù)后1例切口延期愈合，余切口均Ⅰ期愈合，38例均獲隨訪，隨訪時間8～53個月，平均27.8個月。術(shù)后ISOBAR TTL系統(tǒng)固定可靠，無松動、斷裂、后凸畸形；無鄰近節(jié)段退變發(fā)生。動態(tài)固定節(jié)段活動度：0～1° 3例，1～2° 4例，2～3° 14例，3～4° 15例， gt; 4° 2例。末次隨訪時VAS評分為（1.93 ± 2.43）分，較術(shù)前（8.20 ± 1.78）分顯著降低（t=7.761，P=0.000）；下腰痛JOA評分為（23.06 ± 7.75）分，較術(shù)前（4.87 ± 3.44）分顯著增加（t=10.045，P=0.000）。采用Stauffer-Coventry標準評定療效，獲優(yōu)32例，良3例，中2例，差1例，優(yōu)良率為92.1%。 結(jié)論ISOBAR TTL系統(tǒng)治療腰椎退行性疾病近期療效較好。

引用本文： 張力,舒小秋,段揚,葉剛,靳安民. ISOBAR TTL半堅強后路動態(tài)內(nèi)固定系統(tǒng)治療腰椎退行性疾病療效觀察. 中國修復重建外科雜志, 2012, 26(9): 1066-1070. doi: 復制

1. 管俊杰, 石志才. 腰椎動態(tài)固定技術(shù)的臨床研究進展. 脊柱外科雜志, 2010, 8(1): 59-62.
2. Bothmann M, Kast E, Boldt GJ, et al. Dynesys fixation for lumbar spine degeneration. Neurosurg Rev, 2008, 31(2): 189-196.
3. Kumar MN, Jacquot F, Hall H. Long term follow-up of functional outcomes and radiographic changes at adjacent levels following lumbar spine fusion for degenerative disc disease. Eur Spine J, 2001, 10(4): 309-313.
4. Di Silvestre M, Lolli F, Bakaloudis G, et al. Dynamic stabilization for degenerative lumbar scoliosis in elderly patients. Spine (Phila Pa 1976), 2010, 35(2): 227-234.
5. Schaeren S, Broger I, Jeanneret B. Minimum four-year follow-up of spinal stenosis with degenerative spondylolisthesis treated with decompression and dynamic stabilization. Spine (Phila Pa 1976), 2008, 33(18): E636-642.
6. Cakir B, Carazzo C, Schmidt R, et al. Adjacent segment mobility after rigid and semirigid instrumentation of the lumbar spine. Spine (Phila Pa 1976), 2009, 34(12): 1287-1291.
7. Schulte TL, Hurschler C, Haversath M, et al. The effect of dynamic semi rigid implants on the range of motion of lumbar motion segments after decompression. Eur Spine J, 2008, 17(8): 1057-1065.
8. Stauffer RN, Coventry MB. Anterior interbody lumbar spine fusion: analysis of Mayo clinic series. J Bone Joint Surg (Am), 2002, 54(4): 756-758.
9. Lee CK. Accelerated degeneration of the segment adjacent to a lumbar fusion. Spine (Phila Pa 1976), 1988, 13(3): 375-377.
10. Gillet P. The fate of the adjacent motion segments after lumbar fusion. J Spinal Disord Tech, 2003, 16(4): 338-345.
11. Kumar MN, Baklanov A, Chopin D. Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. Eur Spine J, 2001, 10(4): 314-319.
12. Park P, Garton HJ, Gala VC, et al. Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine (Phila Pa 1976), 2004, 29(17): 1938-1944.
13. 鄭曉勇, 侯樹勛, 李利. 腰椎融合術(shù)后相鄰節(jié)段的退變與臨床療效的關(guān)系. 中國矯形外科雜志, 2009, 17(23): 1782-1785.
14. 章篩林, 石志才. 腰椎非融合置入物及其置入技術(shù). 中國組織工程研究與臨床康復, 2008, 12(17): 3333-3336.
15. 朱悅, 崔顯峰. 腰椎后方動態(tài)固定的臨床應用. 中國修復重建外科雜志, 2007 , 21(10): 1099-1103.
16. Lawhorne TW 3rd, Girardi FP, Mina CA, et al. Treatment of degenerative spondylolisthesis potential impact of dynamic stabilization based on imaging analysis. Eur Spine J, 2009, 18(6): 815-822.
17. 李新煒. 非融合技術(shù)在腰椎退行性疾病中的臨床應用. 醫(yī)學綜述, 2011, 17(23): 3578-3581.
18. Perrin G, Cristini A. Prevention of adjacent level degeneration above a fused vertebral segment: Long term effect, after a mean follow-up of 8. 27 years, of the semi-rigid intervertebral fixation as a protective technique for pathological adjacent disc. [s.n]: IMAST, 2003.
19. Stoll TM, Dubois G, Schwarzenbach O. The dynamic neutralization system for the spine a multi center study of a novel non-fusion system. Eur Spine J, 2002, 11 Suppl 2: S170-178.
20. 李偉, 楊慶國. 腰椎后路非融合固定系統(tǒng)的臨床應用進展. 臨床骨科雜志, 2009, 12(5): 578-581.
  1. 1. 管俊杰, 石志才. 腰椎動態(tài)固定技術(shù)的臨床研究進展. 脊柱外科雜志, 2010, 8(1): 59-62.
  2. 2. Bothmann M, Kast E, Boldt GJ, et al. Dynesys fixation for lumbar spine degeneration. Neurosurg Rev, 2008, 31(2): 189-196.
  3. 3. Kumar MN, Jacquot F, Hall H. Long term follow-up of functional outcomes and radiographic changes at adjacent levels following lumbar spine fusion for degenerative disc disease. Eur Spine J, 2001, 10(4): 309-313.
  4. 4. Di Silvestre M, Lolli F, Bakaloudis G, et al. Dynamic stabilization for degenerative lumbar scoliosis in elderly patients. Spine (Phila Pa 1976), 2010, 35(2): 227-234.
  5. 5. Schaeren S, Broger I, Jeanneret B. Minimum four-year follow-up of spinal stenosis with degenerative spondylolisthesis treated with decompression and dynamic stabilization. Spine (Phila Pa 1976), 2008, 33(18): E636-642.
  6. 6. Cakir B, Carazzo C, Schmidt R, et al. Adjacent segment mobility after rigid and semirigid instrumentation of the lumbar spine. Spine (Phila Pa 1976), 2009, 34(12): 1287-1291.
  7. 7. Schulte TL, Hurschler C, Haversath M, et al. The effect of dynamic semi rigid implants on the range of motion of lumbar motion segments after decompression. Eur Spine J, 2008, 17(8): 1057-1065.
  8. 8. Stauffer RN, Coventry MB. Anterior interbody lumbar spine fusion: analysis of Mayo clinic series. J Bone Joint Surg (Am), 2002, 54(4): 756-758.
  9. 9. Lee CK. Accelerated degeneration of the segment adjacent to a lumbar fusion. Spine (Phila Pa 1976), 1988, 13(3): 375-377.
  10. 10. Gillet P. The fate of the adjacent motion segments after lumbar fusion. J Spinal Disord Tech, 2003, 16(4): 338-345.
  11. 11. Kumar MN, Baklanov A, Chopin D. Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. Eur Spine J, 2001, 10(4): 314-319.
  12. 12. Park P, Garton HJ, Gala VC, et al. Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine (Phila Pa 1976), 2004, 29(17): 1938-1944.
  13. 13. 鄭曉勇, 侯樹勛, 李利. 腰椎融合術(shù)后相鄰節(jié)段的退變與臨床療效的關(guān)系. 中國矯形外科雜志, 2009, 17(23): 1782-1785.
  14. 14. 章篩林, 石志才. 腰椎非融合置入物及其置入技術(shù). 中國組織工程研究與臨床康復, 2008, 12(17): 3333-3336.
  15. 15. 朱悅, 崔顯峰. 腰椎后方動態(tài)固定的臨床應用. 中國修復重建外科雜志, 2007 , 21(10): 1099-1103.
  16. 16. Lawhorne TW 3rd, Girardi FP, Mina CA, et al. Treatment of degenerative spondylolisthesis potential impact of dynamic stabilization based on imaging analysis. Eur Spine J, 2009, 18(6): 815-822.
  17. 17. 李新煒. 非融合技術(shù)在腰椎退行性疾病中的臨床應用. 醫(yī)學綜述, 2011, 17(23): 3578-3581.
  18. 18. Perrin G, Cristini A. Prevention of adjacent level degeneration above a fused vertebral segment: Long term effect, after a mean follow-up of 8. 27 years, of the semi-rigid intervertebral fixation as a protective technique for pathological adjacent disc. [s.n]: IMAST, 2003.
  19. 19. Stoll TM, Dubois G, Schwarzenbach O. The dynamic neutralization system for the spine a multi center study of a novel non-fusion system. Eur Spine J, 2002, 11 Suppl 2: S170-178.
  20. 20. 李偉, 楊慶國. 腰椎后路非融合固定系統(tǒng)的臨床應用進展. 臨床骨科雜志, 2009, 12(5): 578-581.