Dynesys动态稳定系统治疗伴邻近节段退变腰椎退变性疾病的临床疗效  

Treatment of degenerative lumbar spine disease with prior adjacent segment degeneration by Dynesys or posterior lumbar interbody fusion

作　　者：朱丹杰[1] 邹成[1] 杨迪[1] 冯法博[1] 李晓林[1] 

机构地区：[1]浙江省人民医院骨科,杭州310014

出　　处：《浙江医学》2016年第23期1882-1886,共5页Zhejiang Medical Journal

摘　　要：目的探讨Dynesys动态稳定系统(Dynesys)治疗伴邻近节段退变腰椎退变性疾病的临床疗效及并发症,并与腰椎后路椎体间融合手术(PLIF)进行比较。方法选择2011年12月至2015年2月伴邻近节段退变的单节段腰椎退变性疾病患者75例,其中采用Dynesys结合后路椎板减压治疗39例(Dynesys组),采用PLIF治疗36例(PLIF组)。记录两组患者术前及末次随访时Oswestry功能障碍指数(ODI)和疼痛视觉模拟量表(VAS)评分;拍摄腰椎正侧位及前屈后伸位X线片,测量手术节段椎间隙高度和活动度。末次随访时进行椎间盘退变UCLA分级评价,并与术前分级进行对比。结果两组患者末次随访时ODI和VAS评分均较术前明显改善(均P<0.05),但两组末次随访组间比较差异均无统计学意义(均P>0.05)。两组患者末次随访时手术节段椎间隙高度均较术前升高,且末次随访时PLIF组均大于Dynesys组,差异均有统计学意义(均P<0.05)。末次随访时两组手术节段活动度均下降,与术前比较差异均有统计学意义(均P<0.05)。按照UCLA分级,Dynesys组39个节段中有4个节段较术前退变加重,PLIF组36个节段中有13个节段较术前退变加重,差异有统计学意义(P<0.05)。两组各有1例出现症状性退变。结论 Dynesys是目前治疗腰椎退变性疾病可选择的一种有效的非融合性内固定技术,虽然对于已存在的邻近节段退变,远期仍有出现症状性邻椎病的可能性,但是在严格掌握适应证的基础上,Dynesys仍然是临床疗效较好的治疗方式。Objective To compare the efficacy of Dynesys（dynamic stabilization system） with posterior lumbar interbody fusion（PLIF） in treatment of degenerative lumbar spine disease with prior adjacent segment degeneration（ASD）. Methods Seventy five cases of lumbar degenerative disease with prior ASD were treated by Dynesys（n=39） or PLIF（n=36） from November2011 to February 2015. The clinical outcome was evaluated by visual analogue scale（VAS） and Oswestry disability index（ODI）.Range of motion（ROM） and the intervertebral height of lumbar segments were measured by X-rays. ASD were assessed by UCLA Grading Scale. Results The ODI and VAS scores significantly improved in each groups at the final follow-up（all P〈0.05）,there was no difference between two groups（all P〉0.05）.The height of disc space increased in both groups at the final follow-up, the height of PLIF group increased more than that of Dynesys group（all P〈0.05）. According to UCLA Grading Scale, there were 4cases in the Dynesys group and 13 in the PLIF group with radiological adjacent segment degeneration（P〈0.05）. 1 case in each group had symptomatic adjacent segment degeneration. Conclusion Dynesys system can provide clinical improvement in degenerative spinal disease with prior ASD if the indications can be strictly controlled.

关 键 词：动态稳定 融合术 腰椎 邻近节段退变 

分 类 号：R687.3[医药卫生—骨科学]