| 【Objective】 To investigate the effect of a domestic dynamic fixation system on the progression of proximal segment degeneration after posterior interbody fusion.【Methods】 Retrospective control study;A retrospective analysis was performed on patients admitted to the Department of Orthopedics,the First Affiliated Hospital of Kunming Medical University from December 2017 to December 2021,diagnosed with lumbar degenerative diseases(including lumbar spinal stenosis and lumbar spondylolisthesis)who underwent posterior fusion and internal fixation and were followed up.Patients were divided into two groups according to whether they underwent prolonged dynamic fixation or not: Observation group(fusion combined with prolonged dynamic fixation operation group),control group(posterior fusion operation group);The Visual Analogue Scale(VAS)scores and Oswestry Disability Index(ODI)scores of patients before,after and at the last follow-up were collected to evaluate the clinical efficacy of patients.Preoperative,postoperative and last follow-up imaging data were collected to measure the intervertebral height ratio(DHI),Pfirrmann grade of intervertebral disc degeneration,intervertebral range of motion(ROM)and other indicators of the segment adjacent to the dynamic protected segment after fusion surgery.The effects of extended dynamic fixation protection and non-dynamic protection on intervertebral disc degeneration were compared by statistical analysis.【Results】 A total of 75 patients were included,and the follow-up time was 12-60 months,with an average follow-up time of 35 months,including 35 patients in the fusion & dynamic protection combined operation group(observation group)and 40 patients in the simple fusion group(control group).All patients’ postoperative symptoms were significantly improved,and the symptoms of back and leg pain were relieved at the first follow-up.1.Clinical efficacy evaluation: The VAS score of the observation group decreased from 6.23±0.77 before surgery to 0.94±0.54 after surgery and 1.60±0.60 at the last follow-up,(P<0.05),and the VAS score of the control group decreased from6.13±0.85 before surgery to 0.88±0.40 after surgery and 1.68±0.62 at the last follow-up,(P<0.05).VAS scores of the two groups were significantly improved compared with those before surgery,but there was no difference between the two groups.The ODI score of the observation group decreased from 17.80±7.33 before surgery to 4.11±0.96 after surgery,and 5.40±1.09 after follow-up,(P<0.05).The ODI score of the control group decreased from 19.63±8.24 before surgery to 3.58±0.81 after surgery,and 5.50±1.75 at the last follow-up,(P<0.05).The ODI score of the two groups was significantly improved compared with that before surgery,and the ODI score of the observation group after surgery was higher than that of the control group(P<0.05),the difference was statistically significant,but the difference before surgery and the last follow-up was not statistically significant.2.Imaging evaluation: DHI in the observation group increased from 0.35±0.09 before surgery to 0.39±0.07 after surgery,and slightly decreased to 0.38±0.08 at the last follow-up.DHI in the observation group was increased after surgery and the last follow-up compared with that before surgery(P<0.05),the difference was statistically significant,while there was no statistically significant change in DHI in the control group before and after surgery(P=0.08).At the last follow-up,it was slightly reduced to 0.35±0.07(P<0.05),and the difference was statistically significant.There was no significant difference in DHI between the two groups before surgery(P=0.22)and after surgery(P=0.23).DHI in the observation group was higher than that in the control group(P<0.05)at the last follow-up,and the difference was statistically significant.At the last follow-up,Pfirrmann grading of the observation group was not statistically different from that of the postoperative group(P=0.16),while that of the control group was higher than that of the postoperative group(P<0.05),and the difference was statistically significant.At the last follow-up,Pfirrmann grading of the two groups was not statistically significant,while the control group was higher than the observation group(P<0.05),and the difference was statistically significant.At the last follow-up,the ROM in the observation group decreased from 6.83±0.86 to3.73±0.45 after surgery(P<0.05),while the ROM in the control group increased from6.78±0.86 to 9.62±1.97 before surgery(P<0.05),and there was no statistical difference between the two groups before surgery.At the last follow-up,the control group was significantly higher than the observation group(P<0.05),with statistical difference.【 Conclusions 】 1.Compared with traditional PLIF surgery,dynamic fixation system protection at adjacent degenerative segments has no significant effect on the clinical effect in the middle postoperative period,and whether there is any difference in the long-term effect remains to be followed up and observed in the later period.2.Compared with traditional PLIF surgery,dynamic fixation system can slow the decline of proximal fusion space and disc degeneration,but partially reduce the range of motion in the fixed space.3.Patients in need of dynamic protection at adjacent segments should be carefully selected according to the actual situation. |
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