| 改良Topping-off技术治疗多节段腰椎退行性疾病 |
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投稿时间：2021-04-19
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| 作者 | Author | 单位 | Address | E-Mail |
| 孔鹏 |
KONG Peng |
山东中医药大学附属医院微创骨科, 山东 济南 250014 |
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| 谭洪栋 |
TAN Hong-dong |
山东省胸科医院骨外科, 山东 济南 250013 |
Department of Orthopaedic Surgery, Shandong Chest Hospital, Jinan 250013, Shandong, China |
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| 张建新 |
ZHANG Jian-xin |
山东中医药大学附属医院微创骨科, 山东 济南 250014 |
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| 汲长蛟 |
JI Chang-jiao |
山东中医药大学附属医院微创骨科, 山东 济南 250014 |
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| 许良 |
XU Liang |
山东省胸科医院骨外科, 山东 济南 250013 |
Department of Orthopaedic Surgery, Shandong Chest Hospital, Jinan 250013, Shandong, China |
844714278@qq.com |
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| 期刊信息：《中国骨伤》2022年，第35卷，第3期，第265-272页 |
| DOI：10.12200/j.issn.1003-0034.2022.03.013 |
| 基金项目:山东省中医药科技发展计划项目（编号:2019-0145） |
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中文摘要:
目的: 探讨采用改良Topping-off技术治疗多节段腰椎退行性疾病的临床疗效。
方法: 自2019年10月至2020年5月，选取84例多节段腰椎退行性疾病患者按临床路径进行手术设计，按照手术方法不同分为改良Topping-off手术治疗组42例（改良Topping-off组）及多节段全椎板减压椎间植骨融合钉棒系统内固定手术42例（全椎板组）。其中改良Topping-off组，男15例，女27例，年龄28~80（59.57±11.85）岁。全椎板组，男14例，女28例，年龄45~82（64.26±9.19）岁。比较两组患者术中出血量、切口长度、手术时间、术后引流量、下地负重时间、住院时间以及椎间隙高度、椎间孔高度、腰椎活动度等影像学指标。比较两组患者术前及术后1、6、12周的腰腿痛视觉模拟评分（visual analogue scale，VAS）和Oswestry 功能障碍指数（Oswestry Disability Index，ODI）。
结果: 所有患者获得12周随访。改良Topping-off组术中出血量、术后引流量少于全椎板组（P<0.05）。改良Topping-off组手术切口长度、手术时间、下地负重时间、住院时间均短于全椎板组（P<0.05）。两组术后12周椎间隙高度、椎间孔高度及腰椎活动度差异有统计学意义（P<0.05）。改良Topping-off组术后1、6、12周VAS均较术前降低（P<0.01），术后12周ODI较术前降低（P<0.01）。全椎板组术后1、6、12周VAS较术前降低（P<0.05），术后12周ODI较术前明显降低（P<0.01）。两组对比术后1、6、12周VAS比较差异有统计学意义（P<0.01）。两组术后12周ODI比较差异有统计学意义（P<0.01）。
结论: 应用改良Topping-off技术治疗多节段腰椎退行性疾病，减少了融合节段总长度，避免或减缓了邻近节段的退变，对维持脊柱的正常运动有积极作用，临床疗效满意。 |
| 【关键词】腰椎 椎间盘退行性变 改良Topping-off技术 |
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| Clinical study on modified Topping-off technology in the treatment of multiple lumbar degenerative diseases |
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ABSTRACT
Objective: To explore the clinical effect of the modified Topping-off technique in the treatment of multiple lumbar degenerative diseases.
Methods: From October 2019 to May 2020,42 patients who underwent modified Topping-off operation (modified Topping-off group) and 42 patients who underwent multilevel total laminectomy and interbody fusion with screw rod system internal fixation (whole laminectomy group) were observed and analyzed. There were 15 males and 27 females in the modified Topping-off group,aged from 28 to 80 years old,with an average of (59.57±11.85)years old. There were 14 males and 28 females in the whole laminectomy group,aged from 45 to 82 years old,with an average of (64.26±9.19) years old. Visual analogue scale (VAS) and Oswestry Disability Index (ODI) were evaluated before operation,1 week,6 weeks and 12 weeks after operation. The intraoperative blood loss,incision length,operation time,postoperative drainage,weight-bearing time,hospitalization time,intervertebral space height,intervertebral foramen height and lumbar mobility were statistically analyzed.
Results: All patients were followed up for 12 weeks. The intraoperative blood loss and postoperative drainage in the modified Topping-off group were significantly less than those in the whole lamina group (P<0.05). The incision length,operation time,weight-bearing time and hospital stay in the modified Topping-off group were shorter than those in the whole lamina group(P<0.05). There were significant differences in intervertebral space height,intervertebral foramen height and lumbar mobility between the two groups at 12 weeks after operation(P<0.05). The modified Topping-off group had significantly lower VAS 1,6,12 weeks after operation and ODI 12 weeks after operation compared with rhose before operation. The VAS at 1,6,12 weeks in the whole lamina group were significantly lower those that before operation(P<0.05). The ODI at 12 weeks in the whole lamina group were significantly lower than those before operation(P<0.01). There were significant differences in VAS scores be tween the two groups at 1 week,6 weeks and 12 weeks after operation(P<0.01). There was significant difference in ODI between the two groups 12 weeks after operation(P<0.01).
Conclusion: The application of modified Topping-off technique in the treatment of multi segmental lumbar degenerative diseases can reduce the total length of fusion segments,avoid or slow down the degeneration of adjacent segments,and has a positive effect on maintaining the normal movement of the spine. |
| KEY WORDS Lumbar vertebrae Intervertebral disc degeneration Modified Topping-off technology |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 孔鹏,谭洪栋,张建新,汲长蛟,许良.改良Topping-off技术治疗多节段腰椎退行性疾病[J].中国骨伤,2022,35(3):265~272 |
| 英文格式: | KONG Peng,TAN Hong-dong,ZHANG Jian-xin,JI Chang-jiao,XU Liang.Clinical study on modified Topping-off technology in the treatment of multiple lumbar degenerative diseases[J].zhongguo gu shang / China J Orthop Trauma ,2022,35(3):265~272 |
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