Dynesys动态内固定联合减压治疗腰椎退行性疾病的中长期临床研究  

Mid-and-long clinical outcomes of Dynesys dynamic internal fixation combined with decompression for the treatment of lumbar degenerative diseases

作　　者：胡勇[1] 钟建斌 袁振山[1] 董伟鑫[1] 田全良 孙肖阳[1] 赖欧杰[1] 朱秉科 张凯伦 Hu Yong;Zhong Jianbin;Yuan Zhenshan;Dong Weixin;Tian Quanliang;Sun Xiaoyang;Lai Oujie;Zhu Bingke;Zhang Kailun(Department of Spine Surgery,Ningbo No.6 Hospital,Ningbo 315040,China;Department of Spine Surgery,Qianxinan Hospital of Chinese Medicine,Xingyi 558000,China)

机构地区：[1]宁波市第六医院脊柱外科,315040 [2]黔西南州中医院脊柱外科,兴义558000

出　　处：《中华骨科杂志》2021年第17期1188-1197,共10页Chinese Journal of Orthopaedics

基　　金：浙江省医药卫生科技计划项目(2021KY327);宁波市公益类科技计划项目(202002N3197)。

摘　　要：目的评估Dynesys动态内固定联合减压治疗腰椎退行性疾病的中长期临床疗效。方法回顾性分析2008年3月至2015年3月采用Dynesys动态内固定联合减压治疗145例腰椎退行性疾病患者,男84例,女61例;年龄(55.9±7.1)岁(范围19~75岁),其中腰椎间盘突出症69例、退行性腰椎管狭窄症53例、Ⅰ度退行性腰椎滑脱症23例。采用视觉模拟评分(visual analogue scale,VAS)、日本骨科学会(Japanese Orthopaedic Association Scores,JOA)腰痛评分(29分)和Oswestry功能障碍指数(Oswestry disability index,ODI)评估手术前后临床症状情况;腰椎侧位X线片测量手术节段与相邻节段椎间隙高度;腰椎动力位X线片测量手术节段与相邻节段椎间活动度(range of motion,ROM);椎间盘Pfirrmann分级系统评估手术节段与邻近节段椎间盘退变情况。结果腰椎间盘突出症患者腰背部和下肢VAS评分、ODI、腰椎JOA评分分别由术前(6.6±1.7)分、(7.1±1.4)分、63.1%±10.2%、(12.5±2.4)分,改善至末次随访时的(2.6±1.0)分、(2.8±0.9)分、30.9%±9.8%、(22.4±2.1)分,差异均有统计学意义。腰椎椎管狭窄症患者腰背部和下肢VAS评分、ODI和腰椎JOA评分分别由术前(6.3±2.2)分、(6.9±1.3)分、63.4%±8.5%、(12.8±2.7)分,改善至末次随访时的(2.4±1.2)分、(2.8±1.0)分、35.1%±12.0%、(22.2±2.2)分,差异均有统计学意义。Ⅰ度退行性腰椎滑脱症患者腰背部和下肢VAS评分、ODI、腰椎JOA评分分别由术前(5.7±2.3)分、(6.7±0.9)分、65.7%±10.0%、(12.5±2.7)分,改善至末次随访时的(2.2±1.2)分、(2.7±1.1)分、37.0%±11.8%、(22.4±2.6)分,差异均有统计学意义。术后1年和末次随访时,手术节段和尾侧椎间隙高度与术前相比均降低,但差异无统计学意义。头侧邻近节段,末次随访时椎间隙高度(11.3±1.8)mm较术前(12.1±1.9)mm和术后1年(11.7±1.6)mm相比下降,差异有统计学意义(F=6.46,P=0.001)。手术节段ROM由术前7.6°±2.2°下降至术后1年时Objective To evaluate the medium and long-term clinical efficacy of the treatment of lumbar degenerative diseases in Dynesys dynamic internal fixation combined with decompression.Methods From March 2008 to March 2015,145 patients(84 males and 61 females,mean age 55.9±7.1 years old)with symptoms of lumbar degenerative diseases(69 lumbar disc herniation,53 lumbar spinal stenosis and 23 I grade lumbar degenerative spondylolisthesis)were treated by the lumbar discectomy using Dynesys dynamic internal fixation combined with decompression.The clinical symptoms before and after surgery were assessed by visual analogue scale(VAS),Japanese Orthopaedic Association(JOA)and Oswestry disability index(ODI).Lumbar lateral radiographs were used to measure the height of intervertebral space between the surgical segment and the adjacent segment.The range of motion(ROM)between the surgical segment and the adjacent segment was measured by lumbar dynamic position X-ray.Surgical and adjacent segments degenerative were classified according to the Pfirrmann grade classification.Results The VAS score,ODI and JOA score of lower back and lower limbs in patients with lumbar disc herniation were improved from 6.6±1.7,7.1±1.4,63.1%±10.2%,12.5±2.4 preoperatively to 2.6±1.0,2.8±0.9,30.9%±9.8%,22.4±2.1 at the latest follow-up.The differences were statistically significant.The VAS score,ODI score and JOA score of lower back and lower limbs in patients with lumbar spinal stenosis were improved from 6.3±2.2,6.9±1.3,63.4%±8.5%,12.8±2.7 preoperatively to 2.4±1.2,2.8±1.0,35.1%±12.0%,22.2±2.2 at the latest follow-up.The differences were statistically significant.The VAS score,ODI score and JOA score of lower back and lower limbs in patients with I degree lumbar degenerative spondylolisthesis were improved from 5.7±2.3,6.7±0.9,65.7%±10.0%,12.5±2.7 preoperatively to 2.2±1.2,2.7±1.1,37.0%±11.8%,22.4±2.6 at the latest follow-up.The differences were statistically significant.Comparing to preoperational value,the height of the operat

关 键 词：腰椎 椎管狭窄 椎间盘移位 脊椎前移 内固定器 

分 类 号：R687.3[医药卫生—骨科学]