| Objective:The aim of this study is to investigate whether the WaveFlex semi-rigid internal fixation system can effectively delay the degeneration of cranial adjacent segments under the guidance of the theory of "dynamic and static integration" by comparing the mid-term clinical efficacy and imaging parameters of two-segment posterior rigid fusion system(PLIF)and WaveFlex semi-rigid internal fixation system in the treatment of lumbar degenerative diseases.To improve the sagittal imbalance of the spine,so as to provide a basis for the selection of clinical surgical options.Methods:From January 2016 to October 2017,50 patients with lumbar degenerative diseases were treated in Department of Spinal Orthopedics,Affiliated Hospital of Shandong University of Traditional Chinese Medicine.Among them,25 patients were treated with WaveFlex semi-rigid internal fixation system(Waveflex group),and 25 patients with Waveflex semi-rigid internal fixation system(Waveflex group).Twenty-five patients were treated with two-level posterior rigid fusion fixation(PLIF group).Visual analogue Scale(VAS)and Oswestry disability Index(ODI)were used to evaluate the clinical efficacy.In terms of objective imaging indicators,we collected of preoperative and postoperative 3 months,1 year after operation,postoperative adjacent segment at the time of 5 years follow-up cephalic index of intervertebral height(DHI),adjacent segment head side height of intervertebral foramen(IFH),adjacent segment head lateral lumbar segment of motion(ROM),lumbar lordosis Angle(LL),lumbar lordosis Angle and pelvic incidence Angle difference between absolute value(|PI-LL|),pelvic incidence Angle(PI),pelvic tilt(PT)and sacral slope(SS).Results:There were no significant differences in baseline data such as age,operation time,intraoperative blood loss,postoperative ambulation time,follow-up time and preoperative evaluation indexes between the two groups(P>0.05).There was no significant difference in VAS score and ODI score between Waveflex group and PLIF group before operation and at each follow-up time(P>0.05).The VAS scores of Waveflex group and PLIF group at each follow-up time after operation were significantly different from those before operation(P<0.05).In terms of imaging parameters,there was no significant difference in DHI index between Waveflex group and PLIF group before operation and 3 months after operation(P>0.05),but there was significant difference in DHI index between Waveflex group and PLIF group at 1 year and 5 years after operation(P<0.05).There was no significant difference in DHI index between 3 months after operation and before operation in Waveflex group and PLIF group(P>0.05),but there was significant difference between 1 year and 5 years after operation and before operation(P<0.05).In terms of IFH index,there was no significant difference between the two groups before operation and 3 months after operation(P>0.05),but there was significant difference between 1 year and 5 years after operation(P<0.05).In Waveflex group,there was no significant difference in IFH index between 3 months and 1 year after operation(P>0.05),but there was significant difference between 5 years after operation and before operation(P<0.05).In PLIF group,there was no significant difference in IFH index between 3 months after operation and before operation(P>0.05),but there was significant difference between 1 year and 5 years after operation and before operation(P<0.05).In terms of ROM value,there was no significant difference between the two groups before operation(P>0.05),but there was significant difference between the two groups at 3 months,1 year and 5 years after operation(P<0.05).In Waveflex group,there was no significant difference in ROM between 3 months after operation and before operation(P>0.05),but there was significant difference between 1 year after operation and 5 years after operation(P<0.05).The ROM values in PLIF group at 3 months,1 year and 5 years after operation were significantly different from those before operation(P<0.05).The comparison of LL values between the two groups showed that there was no significant difference between the two groups before operation and 3 months after operation(P>0.05),but there was significant difference between the two groups at 1 year and 5 years after operation(P<0.05).In Waveflex group,there was no significant difference in LL value between 3 months after operation and before operation(P>0.05),but there was significant difference between 1 year and 5 years after operation and before operation(P<0.05).In PLIF group,there was no significant difference in LL value between 3 months and 5 years after operation(P>0.05),but there was significant difference between 1 year after operation and before operation(P<0.05).In terms of PI values,there was no significant difference between the two groups before operation,3 months,1 year and 5 years after operation(P>0.05).There was no significant difference in PI values between Waveflex group and PLIF group at 3 months,1 year and 5 years after operation(P>0.05).In |PI-LL| group,according to the comparison between numerical aspects contrast both preoperative and postoperative 3 months there was no statistical significance(P>0.05)difference contrast,after 1 year,5 years after contrast difference was statistically significant(P<0.05).Waveflex way in |PI-LL|numerical postoperative 3 months,1 year after operation,postoperative 5 years compared with preoperative difference was statistically significant(P<0.05);PLIF way in |PI-LL|numerical postoperative 3 months there was no statistically significant difference compared with preoperative(P>0.05),and 1 year after operation,postoperative 5 years compared with preoperative difference was statistically significant(P<0.05);There was no significant difference in PT value between the two groups before operation,3 months and 1 year after operation(P>0.05),but there was significant difference in PT value at 5 years after operation(P<0.05).In Waveflex group,PT values at 3 months,1 year and 5 years after operation were significantly different from those before operation(P<0.05).In PLIF group,there was no significant difference in PT value between 3 months after operation and before operation(P>0.05),but there was significant difference between 1 year after operation and 5 years after operation(P<0.05).There was no significant difference in SS value between the two groups before operation and 3 months after operation(P>0.05),but there was significant difference in SS value between 1 year and 5 years after operation(P<0.05).In Waveflex group,there was no significant difference in SS between 3 months after operation and before operation(P>0.05),but there was significant difference between 1 year and 5 years after operation and before operation(P<0.05).In the PLIF group,there was no significant difference in SS at 3 months,1 year,and 5 years after operation compared with that before operation(P>0.05).Conclusion:1.Locally in the surgical area,Waveflex semi-rigid dynamic fixation system can delay the reduction of the intervertebral space height index and foraminal height in the proximal cephalic segment of the surgical segment,and at the same time delay the adverse increase of the range of motion in the proximal cephalic segment,thus effectively delaying the degeneration of the upper adjacent segment of the disc.2.From the perspective of long-term postoperative clinical efficacy,Waveflex semi-rigid dynamic fixation system can improve the lumbar kyphosis Angle and spinal sagittal imbalance.3.Generally speaking,the Waveflex semi-rigid dynamic fixed system under the guidance of the "dynamic and static combination" theory coordinates the dynamic and static balance between the whole and local,local and local,which can effectively delay the degeneration of the cephalic adjacent segment,improve the spinal sagittal position imbalance,improve the quality of life of patients after surgery,and has a good promotion value. |
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