腰椎后路动态稳定系统修复退行性腰椎椎管狭窄:疗效及安全性分析  

Posterior lumbar dynamic stabilization system in the treatment of degenerative lumbar spinal stenosis: efficacy and safety

作　　者：邓勇 向静 Deng Yong;Xiang Jing(Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China;Medical School, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China)

机构地区：[1]西南医科大学附属医院骨关节外科,四川省泸州市646000 [2]西南医科大学附属医院卫校,四川省泸州市646000

出　　处：《中国组织工程研究》2018年第15期2333-2339,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景:腰椎后路动态稳定系统属于新的非融合技术,是治疗腰椎退行性疾病的新方法,主要包括棘突间固定系统和经椎弓根固定的动态后路装置,其中Wallis系统和Dynesys系统是两种不同部位固定系统的代表,关于这两种系统在退变性腰椎椎管狭窄治疗中的疗效比较鲜有报道。目的:比较Wallis系统棘突间固定、Dynesys系统经椎弓根固定及融合术修复退变性腰椎椎管狭窄的有效性与安全性。方法:自愿接受手术治疗的退变性腰椎椎管狭窄患者79例,按固定方式分为3组:融合组30例接受充分减压联合腰椎后路椎间融合术;Wallis组25例接受充分减压联合棘突间Wallis固定;Dynesys组24例接受充分减压联合Dynesys系统经椎弓根固定。所有患者术后3年随访资料完整。结果与结论:(1)3组患者基线资料、术中出血量和术后引流量均无明显差异(P>0.05);融合组手术时间明显长于其他两组(P<0.05);(2)Wallis组和Dynesys组间脊髓功能评分、腰腿痛目测类比评分、Oswestry功能障碍指数和影像学测量指标比较均无明显差异(P>0.05);融合组术后3年脊髓功能评分和Oswestry功能障碍指数均明显降低(P<0.01),Wallis组和Dynesys组术后1个月的脊髓功能评分和Oswestry功能障碍指数较融合组均明显降低(P<0.01),3组术后手术节段活动范围明显降低(P<0.01),Wallis组和Dynesys组较融合组的手术上下位相邻节段活动范围明显升高,3组手术节段椎间高度、椎间孔高度和椎间孔面积均较术前明显增高(P<0.01);(3)3组临床疗效评价与并发症发生率无明显差异(P>0.05)。说明腰椎后路动态稳定系统(Wallis和Dynesys系统)内固定治疗退变性腰椎椎管狭窄症能有效缓解下腰痛和维持腰椎功能与活动度,近期疗效可靠。BACKGROUND： Lumbar posterior dynamic stabilization system is a new nonfusion method for the treatment of lumbar degenerative disease, mainly including interspinous dynamic fixation system and the posterior pedicle fixation device. Wallis system and Dynesys system are representative of two different fixation systems. There is little study on above two fixation systems in the treatment of degenerative lumbar spinal stenosis.OBJECTIVE： To compare the effectiveness and safety of Wallis system interspinous fixation, Dynesys system transpedicular fixation and fusion in the treatment of degenerative lumbar spinal stenosis.METHODS： Totally 79 cases of degenerative lumbar spinal stenosis voluntarily receiving the surgery were divided into three groups according to fixation mode. In the fusion group, 30 cases underwent full decompression combined with posterior lumbar interbody fusion. In the Wallis group, 25 cases underwent full decompression combined with interspinous Wallis fixation. In the Dynesys group, 24 cases underwent full decompression combined with pedicle screw fixation with Dynesys system. The follow-up data of all patients were complete at postoperative 3 years. RESULTS AND CONCLUSION： （1） There was no significant difference in baseline data, intraoperative bleeding and postoperative drainageRESULTS AND CONCLUSION： （1） There was no significant difference in baseline data, intraoperative bleeding and postoperative drainage volume among the three groups （P 〉 0.05）. The operation time of the fusion group was obviously longer than in the other two groups （P 〈 0.05）. （2） There were no significant differences between the Wallis group and the Dynesys group in spinal function scores, visual analogue score of the low back pain, the Oswestry dysfunction index and the imaging measurement indexes （P 〉 0.05）. The spinal function score and Oswestry dysfunction index of the fusion group were significantly decreased at postoperative 3 years （P 〈 0.01）. The spinal function score a

关 键 词：后路动态稳定系统 相邻节段退变 脊柱外科 Wallis系统 Dynesys系统 脊柱植入物 腰椎退行性疾病 椎管狭窄 非融合技术 融合技术 骨科植入物 

分 类 号：R318[医药卫生—生物医学工程]