经椎弓根动态稳定系统(Dynesys)与后路椎间融合治疗腰椎管狭窄症的临床比较研究  

A comparative study between dynamic internal fixation(Dynesys) and posterior lumbar interbody fusion in treating lumbar spinal stenosis

作　　者：樊友亮[1] 吴一雄[1] 胡辉东[1] 丁亮华[2] 陆佳俊[1] 黄小斐[1] 文会龙[1] 杨光[1] 

机构地区：[1]江苏省常州市肿瘤医院骨科,213001 [2]苏州大学附属第三医院骨科

出　　处：《中国骨与关节损伤杂志》2013年第11期1016-1019,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的比较单节段椎弓根动态稳定系统(Dynesys)与后路椎间融合治疗退行性腰椎管狭窄症的早期临床疗效与影像学改变。方法自2008-08—2011-03对24例L4、5椎管狭窄症分别采用后路减压联合椎弓根动态稳定系统(A组)与后路减压、椎间融合术(B组)治疗。结果两组手术时间及术中出血量比较,差异有统计学意义(P<0.05),两组手术切口长度比较,差异无统计学意义(P>0.05)。末次随访时A、B组VAS、JOA评分及ODI均优于术前,差异有统计学意义(P<0.05);L4、5相对椎间隙高度A、B两组末次随访均较术前明显提高,两组手术前后比较差异均有统计学意义(P<0.05)。B组L3、4椎间活动度较术前增大,差异有统计学意义(P<0.05);A组L4、5末次随访时椎间活动度与术前比较差异有统计学意义(P<0.05)。结论经椎弓根动态稳定系统(Dynesys)与后路椎间融合治疗退行性腰椎管狭窄症疗效相当,但前者内固定具有创伤小、手术时间短,出血少、可以提供足够的脊柱稳定性,延缓及防止相邻节段的退变。Objective To compare the effectiveness and radiological changes after monosegmental posterior dynamic stabilization and lumbar fusion for lumbar spinal stenosis. Methods Between-August 2008 and March 2011, a comparative study was earried out on patients with lumbar spinal stenosis at L4,5. Patients in group A underwent posterior decompression combined with Dynesys and patients in group B underwent posterior decompression combined with posterior lumbar interbody fusion treatment. Results ：Th.ere was significant differenee between two groups in blood loss and operative time（P 〈0.05） and no significant difference between two g^ups in incision length （P 〉0.05）. At the last folio,d-up, the JOA, VAS seores and ODI of groups A and B were signifieantl~ improved compared with the preoperative values（P 〈0.05）. There was significant difference in the relative height of intervertebral ofL43 of groups A and B between pre- and post-operation（P 〈0.05）. In group B, the ROM of ~,4 was significantly reduction （P 〈0.05） compared with the preoperative one. Compared with preoperative the ROM of L,5 in group A was signifieantly reduetion （P 〈0.05）. Conclusion Posterior deeompression eombined with Dynesys has the same effectiveness as posterior lumbar interbody fusion in treating lumbar spinal stenosis at L43. But the former has less invasive, shoter time and little hemorrhage ,and, it ean provide enough stability, delay and prevent the adjacent segments degeneration.

关 键 词：腰椎 椎管狭窄症 DYNESYS 椎间融合 内固定 

分 类 号：R687.3[医药卫生—骨科学]