腰椎弹性棒动态固定治疗腰椎椎管狭窄邻近节段退变的疗效分析

Efficacy of novel dynamic fixation for the prevention of adjacent segment degeneration after treating lumbar spinal stenosis

摘要:

目的 比较脊柱融合辅以邻近节段弹性棒动态固定与单纯脊柱融合治疗腰椎椎管狭窄邻近节段退变（ASD）的临床疗效。方法 选取2019年12月—2021年4月在郴州市第一人民医院行手术治疗的40例腰椎椎管狭窄患者。将其随机分为A、B组，每组20例。A组行脊柱融合辅以邻近节段弹性棒动态固定，B组行单纯脊柱融合。分析两组患者术前及术后1 d、3个月、6个月、12个月的腰痛视觉模拟评分（VAS）、腰椎Oswestry功能障碍指数（ODI）评分、术后固定节段和动态固定邻近节段椎间隙高度比值（ISR）、邻近节段腰椎活动度（ROM）、邻近节段腰椎间盘退变Pfirrmann分级的变化。结果 两组患者术前及术后1 d、3个月、6个月、12个月的VAS、ODI评分比较，采用重复测量设计的方差分析，结果 ①不同时间点VAS、ODI评分有差异（F =575.55和1436.967，均P =0.000）；②A与B组VAS、ODI评分无差异（F =2.402和1.952，P =0.129和0.171）；③两组VAS、ODI评分变化趋势有差异（F =6.469和9.116，均P =0.000）。两组患者术前及术后1 d、3个月、6个月、12个月的ISR、ROM、Pfirrmann分级比较，采用重复测量设计的方差分析，结果 ①不同时间点ISR、ROM有差异（F =65.454和614.002，均P =0.000），Pfirrmann分级无差异（F =1.221，P =0.305）；②A与B组ISR、ROM、Pfirrmann分级有差异（F =31.005、649.492和18.185，均P =0.000）；③两组ISR、ROM、Pfirrmann分级变化趋势有差异（F =7.420、213.145和19.963，均P =0.000）。结论 脊柱融合辅助以弹性棒动态固定治疗腰椎椎管狭窄，可以保留脊柱活动度，有效维持邻近节段的椎间高度，分散加载至邻近节段椎间盘的力学载荷，有效改善腰椎椎管狭窄ASD患者的临床症状和预后。

Abstract:

Objective To compare the clinical efficacy of lumbar spinal fusion combined with novel dynamic fixation versus lumbar spinal fusion alone in the prevention of adjacent segment degeneration (ASD) after treating lumbar spinal stenosis.Methods A total of 40 patients with lumbar spinal stenosis admitted to the First People's Hospital of Chenzhou from December 2019 to April 2021 were selected and divided into two groups, with 20 cases in each group. The group A was treated with lumbar spinal fusion and novel dynamic fixation, while the group B was treated with lumbar spinal fusion alone. The Visual Analogue Scale (VAS) scores, Oswestry Disability Index (ODI), and the intervertebral space ratio (ISR), lumbar spine range of motion (ROM) and Pfirrmann classification of adjacent segments before, and 1 day, 3 months, 6 months and 12 months after the operation were analyzed and compared between the two groups.Results The VAS score and ODI before, and 1 day, 3 months, 6 months and 12 months after the operation in the two groups were compared via repeated measures analysis of variance, and the results showed that the VAS score and ODI were different among the time points (F = 575.55 and 1436.967, both P = 0.000). There was no significant difference in VAS score or ODI between the two groups at different time points (F = 2.402 and 1.952, P = 0.129 and 0.171). The change trends of VAS score and ODI were different between the two groups (F = 6.469 and 9.116, both P = 0.000). The ISR, lumbar spine ROM and Pfirrmann classification of adjacent segments before, and 1 day, 3 months, 6 months and 12 months after the operation in the two groups were also compared via repeated measures analysis of variance, which revealed that ISR and lumbar spine ROM (F =65.454 and 614.002, both P =0.000) rather than Pfirrmann classification (F =1.221, P =0.305) of adjacent segments were different among the time points and that they were all discrepant between the two groups (F =31.005, 649.492 and 18.185, all P =0.000). Besides, the change trends of them differed between the two groups (F =7.420, 213.145 and 19.963, all P =0.000).Conclusions For the treatment of lumbar spinal stenosis, novel dynamic fixation effectively preserves the lumbar spine ROM, maintains the intervertebral height of adjacent segments, redistributes the mechanical load on the intervertebral disc of adjacent segments, and improves the clinical symptoms and prognosis of patients after lumbar spinal fusion.