Dynesys动态内固定治疗腰椎间盘突出症的长期动力学分析  

Long-term dynamic analysis of dynamic internal fixation with Dynesys for lumbar disc herniation

作　　者：齐雨[1] 李江涛[1] 牛宇 张拓[1] QI Yu;LI Jiang-tao;NIU Yu;ZHANG Tuo(Department of Orthopedics,Qinhuangdao Chinese Medicine Hospital,Qinhuangdao 066000,Hebei,China)

机构地区：[1]秦皇岛市中医医院骨科,河北秦皇岛066000

出　　处：《川北医学院学报》2020年第3期465-470,共6页Journal of North Sichuan Medical College

摘　　要：目的:探讨和分析Dynesys动态内固定治疗腰椎间盘突出症的长期临床疗效及腰椎动力学指标变化以及两者之间相关性。方法:回顾性分析进行Dynesys动态内固定治疗的70例患者以及同期接受融合术治疗的90例腰椎间盘突出症患者临床资料,分别将其作为研究组和对照组,比较两组患者术后疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)等临床疗效指标以及椎间隙高度、椎间活动度(ROM)、腰椎前凸角(LL)、UCLA椎间隙退变分级(UCLA)等腰椎动力学指标变化情况。并采用Pearson相关性分析动力学指标变化情况与ODI评分之间的相关性。结果:末次随访时,两组患者VAS评分和ODI评分较术前均明显下降,且研究组改善程度优于对照组(P<0.05)。两组患者手术节段ROM较治疗前均明显下降(P<0.05),其中对照组ROM为0,研究组仍保留一部分ROM(平均3.42°)。两组患者末次上位邻近节段ROM较手术治疗前均明显升高,但研究组升高程度小于对照组(P<0.05)。研究组治疗后上位整体节段ROM相比术前虽有所升高,腰椎整体ROM相比术前有所下降,但两者差异无统计学意义(P>0.05);对照组上位整体节段和腰椎整体ROM分别较术前明显上升和下降(P<0.05)。对照组手术节段椎间高度相比治疗前有所增加,但差异无统计学意义(P>0.05),研究组较治疗前明显下降(P<0.05)。研究组和对照组上位邻近节段椎间高度较术前均有下降,且对照组下降程度更显著(P<0.05)。两组手术节段前凸角较治疗前下降,但仅研究组存在统计学差异(P<0.05)。两组患者手术后UCLA分级较术前均明显改善(P<0.05)。Pearson相关性分析结果显示,研究组手术节段ROM、腰椎整体ROM、上位整体节段ROM以及腰椎整体前凸角均与ODI评分之间存在显著负相关性(P<0.05),对照组腰椎整体ROM、腰椎整体前凸角与ODI评分之间也存在显著负相关性(P<0.05)。结论:Dynesys动态内固定治疗�Objective:To investigate and analyze the long-term clinical efficacy and dynamics of lumbar disc herniation in the treatment of lumbar disc herniation with Dynesys dynamic internal fixation and the correlation between them.Methods:Retrospective analysis was performed on the clinical data of 70 patients and 90 patients with lumbar disc herniation treated by fusion during the same period,and they were used as study group and control group respectively.The clinical efficacy indexes such as visual analogue scale(VAS)and Oswestry disability index(ODI),lumbar vertebral dynamics indicators such as intervertebral space height,range of motion(ROM),lumbar lordosis(LL),UCLA intervertebral space degeneration(UCLA)changes were compared between the two groups.And pearson correlation was used to analyze the correlation between changes in kinetic indicators and ODI scores.Results:At the last follow-up,the VAS score and ODI score of the two groups were significantly lower than those before the operation,and the improvement of the study group was significantly better than that of the control group(P<0.05).The ROM of the surgical segment was significantly lower than that before treatment(P<0.05).The ROM of the control group was 0,and the study group still retained a part of ROM(average 3.42°).The last upper adjacent segment ROM of the two groups was significantly higher than that before the operation,but the increase of the study group was smaller than that of the control group(P<0.05).After treatment,the upper segmental ROM of the study group was higher than that before surgery.The overall ROM of the lumbar spine decreased compared with that before surgery,but the difference was not statistically significant(P>0.05).The overall segmental and lumbar spine of the control group increased significantly and significantly decreased compared with the preoperative(P<0.05).The intervertebral height of the control group was increased compared with that before treatment,but the difference was not statistically significant(P>0.05).The study

关 键 词：Dynesys系统 内固定 腰椎间盘突出症 邻近节段退变 长期动力学 

分 类 号：R687.3[医药卫生—骨科学]