动态固定与椎间融合治疗腰椎退行性滑脱的比较  

Comparison of dynamic stabilization versus interbody fusion for degenerative lumbar spondylolisthesis

作　　者：罗磊 赵晨 周强 刘列华 李培 罗飞 侯天勇 梁利川 高永建 LUO Lei;ZHAO Chen;ZHOU Qiang;LIU Lie-hua;LI Pei;LUO Fei;HOU Tian-yong;LIANG Li-chuan;GAO Yong-jian(Department of Orthopedics,The Third Affiliated Hospital,Chongqing Medical Universityy Chongqing 401120,China;Department of Orthopaedics,The First Affiliated Hospital,Army Medical University,Chongqing 400038,China)

机构地区：[1]重庆医科大学附属第三医院脊柱外科,重庆401120 [2]陆军军医大学第一附属医院骨科,重庆400038

出　　处：《中国矫形外科杂志》2021年第11期966-970,共5页Orthopedic Journal of China

摘　　要：[目的]比较Dynesys动态固定与经椎间孔椎间融合术(transforaminal lumbar interbody fusion,TLIF)治疗腰椎退行性滑脱症的临床疗效。[方法]2012年4月—2017年4月,共113例L4椎退行性I度滑脱症患者纳入本研究。依据术前医患沟通结果,52例采用Dynesys动态固定,61例采用TLIF融合术。比较两组患者的围手术期、随访和影像资料。[结果]动态组手术时间短于融合组(P<0.05),出血量少于融合组,但差异无统计学意义(P>0.05)。两组患者均获12个月以上随访。随时间推移,两组患者的腰痛和腿痛VAS评分以及ODI指数均显著下降(P<0.05)。末次随访时动态组腿痛VAS评分[(1.58±0.76)分vs(2.02±0.98)分,P<0.05]和ODI指数[(16.73±8.58)%vs(20.91±11.69)%,P<0.05]均显著低于融合组。影像方面,与术前相比,术后1周动态组L4椎体滑移距离显著减少,复位率43.91%(P<0.05),末次随访时复位效果有一定丢失,复位率平均27.20%,但无腰椎矢状面不稳。末次随访时动态组L4/5椎间隙活动度明显高于融合组[(3.93±2.48)°vs(1.12±0.60)°,P<0.05]。[结论]Dynesys动态固定与TLIF治疗L4椎退行性I度滑脱症均能取得较好的临床效果,但Dynesys动态固定手术时间更短,且保留了固定节段部分活动度。虽然复位效果欠佳,但Dynesys动态固定能有效稳定腰椎,阻止滑脱进展。[Objective]To compare the clinical outcomes of Dynesys dynamic fixation and transforaminal lumbar interbody fusion(TLIF)in the treatment of lumbar degenerative spondylolisthesis.[Methods]From April 2012 to April 2017,a total of 113 patients with grade I degenerative L4 spondylolisthesis were included in this study.According to the consequences of preoperative doctor-patient communication,52 patients received Dynesys dynamic fixation,while the remaining 61 patients had TLIF fusion performed.The perioperative,follow-up and imaging data were compared between the two groups.[Results]The dynamic group consumed significantly shorter operation time(P<0.05),associated with less the blood loss than the fusion group,despite of the fact that the latter.s difference was not statistically significant(P>0.05).Patients in both groups were followed up for more than 12 months.The VAS scores for low back pain and leg pain,as well as ODI score decreased significantly over time in both groups(P<0.05).At the last follow-up,the dynamic group proved significantly superior to the fusion group in term of the VAS score of leg pain[(1.58±0.76)vs(2.02±0.98),P<0.05]and the ODI score[(16.73±8.58)vs(20.91±11.69),P<0.05].With respect of imaging assesment,the dynamic group got significant decrease of the L4 sliding distance at 1 week after operation with reduction rate of 43.9%,compared with that preoperatively(P<0.05),whereas the reduction was slightly lost at the latest follow-up with reduction rate of 27.2%.However,no signs of sagittal instability of the lumbar spine were found in anyone of the patients in the dynamic group.In addition,the dynamic group had significantly greater motion of the L4/5 intervertebral space than the fusion group at the latest follow-up[(3.93±2.48)vs(1.12±0.60),P<0.05].[Conclusion]Both Dynesys dynamic fixation and TLIF can achieve satisfactory clinical outcomes for grade I degenerative L4 spondylolisthesis.By comparison,the Dynesys dynamic fixation takes advantages of shorter operation time,retaining partial m

关 键 词：腰椎退行性滑脱症 动态固定 经椎间孔椎间融合术 

分 类 号：R687.4[医药卫生—骨科学]