Dynesys动态固定系统治疗伴多裂肌脂肪浸润的腰椎退行性疾病的中期疗效  

The mid-term clinical effect observation of Dynesys applied to the treatment of lumbar degenerative diseases with fatty infiltration of multifidus muscle

作　　者：邵进[1] 孔德策 杨铁毅[1] 张岩[1] 刘树义[1] 刘粤[1] 赵一丁 周文超 叶维光 Shao Jin;Kong Dece;Yang Tieyi;Zhang Yan;Liu Shuyi;Liu Yue;Zhao Yiding;Zhou Wenchao;Ye Weiguang(Department of Orthopedics,Pudong New Area Gongli Hospital,Shanghai 200135,China)

机构地区：[1]上海市浦东新区公利医院骨科,200135

出　　处：《中华骨科杂志》2021年第17期1198-1208,共11页Chinese Journal of Orthopaedics

基　　金：上海市浦东新区临床特色学科建设项目(PWYts2018-03)。

摘　　要：目的探讨Dynesys动态固定系统治疗伴多裂肌脂肪浸润的腰椎退行性疾病的临床效果。方法回顾性收集2015年1月至2017年12月53例采用Dynesys动态固定系统治疗伴多裂肌脂肪浸润的腰椎退行性疾病患者资料,其中男21例,女32例;年龄(66.2±7.4)岁(范围48~81岁)。其中腰椎管狭窄症37例,腰椎间盘突出症16例;责任节段包括L2~S13例,L3~S113例,L2~L55例,L4~S117例,L3~L515例。手术沿Wiltse手术入路,以上关节突外缘和横突中线连线的交点为进针点置入椎弓根螺钉,切除突出椎间盘及增生黄韧带,使用弹性绳将间隔器套入上下椎弓根螺钉间,收紧加压后固定。术后采用MR检查多裂肌脂肪浸润程度、头侧邻近节段活动度(range of motion,ROM)、椎间高度(intervertebral height,IH)、腰椎前凸角(lumbar lordosis,LL)、骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacral slop,SS),并采用Japanese Orthopaedic Association(JOA)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)、健康调查简表(the MOS 36-item short-form health survey,SF-36)和视觉模拟评分(visual analog scale,VAS)。结果手术时间(173.5±64.7)min(范围125~240 min);术中出血量(469.5±118.2)ml(范围380~620 ml)。术后随访(47.9±6.7)个月(范围38~62个月)。末次随访MR检查示多裂肌脂肪浸润程度未见进一步加重。ROM由术前6.05°±1.85°增至6.93°±1.87°,IH由术前(10.97±2.11)mm增至(11.05±2.02)mm,差异均无统计学意义(P>0.05);腰椎前凸角由术前37.6°±8.8°增大至43.2°±9.1°,PT由术前24.7°±9.3°减小至20.5°±5.1°,SS由术前22.1°±7.7°增大至26.3°±8.0°,差异均有统计学意义(均P<0.05);JOA评分由术前(6.4±1.2)分增加至术后3个月(19.8±1.6)分、术后1年(22.3±0.9)分、末次随访(20.6±2.8)分,差异有统计学意义(P<0.05)。ODI由术前50.6%±11.3%降至术后3个月13.8%±4.7%、术后1年11.9%±2.8%、末次随访13.0%±3.4%,差异有统计学意义(P<Objective To investigate the clinical effect of Dynamic neutralization system applied to the treatment of lumbar degenerative diseases with fatty infiltration of multifidus muscle.Methods From Jan 2015 to Dec 2017,a total of 53 patients of lumbar degenerative diseases with multifidus fatty infiltration treated by Dynesys in our hospital were analyzed,included 21 males and 32 females,aged 66.2±7.4(range 48-81)years.There were lumbar spinal stenosis in 37 casesand lumbar disc herniationin 16 cases;the index level included L2-S1 in 3 cases,L3-S1 in 13 cases,L2-L5 in 5 cases,L4-S1 in 17 cases,and L3-L5 in 15 cases.The pedicle screws were inserted at the point of intersection of the outer edge of superior articular process and the midline of transverse process.After discectomy of herniated disc and hyperplastic ligamentum flavum,the distance between the upper and lower pedicle screws was measured and then the spacer of the corresponding length was cut out.Finally,the spacer was placed and fixed between the upper and lower pedicle screws by the elastic rope.The degree of multifidus fat infiltration,lumbar lordosis(LL),pelvic incidence(PI),pelvic tilt(PT),sacral slop(SS),range of motion(ROM),intervertebral height(IH),Japanese Orthopaedic Association(JOA)score,Oswestry disability index(ODI),the MOS 36-item short-form health survey(SF-36)and visual analog scale(VAS)were evaluated postoperatively.Results The operation was performed successfully in all the patients.The operation duration was 173.5±64.7(range 125-240)min.Intraoperative blood loss was 469.5±118.2(range 380-620)ml.The patients were followed up for 47.9±6.7(range 38-62)months averagely.At the last follow-up,the degree of fatty infiltration of the multifidus muscle showed no further progress by MR scan.There was no significant difference in ROM and IH at different time points preoperativelyand postoperatively.The LL recovered from 37.6°±8.8°to 43.2°±9.1°,the PT decreased from 24.7°±9.3°to 20.5°±5.1°,and the SS increased from 22.1°±7.7°to 26.3�

关 键 词：腰椎 椎旁肌 磁共振成像 治疗结果 内固定器 

分 类 号：R687.3[医药卫生—骨科学]