Dynesys动态内固定治疗Ⅰ度退行性腰椎滑脱症的中期疗效  

Mid-term efficacy of Dynesys dynamic internal fixation in the treatment of grade I degenerative lumbar spondylolisthesis

作　　者：苗磊 马宁[1] 麻昊宁[2] 王轩获 蔡利军[1] 王一农[1] Miao Lei;Ma Ning;Ma Haoning;Wang Xuanhuo;Cai Lijun;Wang Yinong(Department of Spinal Orthopaedics,People's Hospital of Ningxia Hui Autonomous Region,Yinchuan 750011,China;The Second Department of Orthopaedics,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]宁夏回族自治区人民医院脊柱骨科,银川750011 [2]中日友好医院骨科二部,北京100029

出　　处：《中华骨科杂志》2021年第17期1227-1236,共10页Chinese Journal of Orthopaedics

基　　金：宁夏回族自治区人民医院培育振兴科研项目(201906)。

摘　　要：目的探讨Dynesys内固定及后路椎体间融合术(posterior lumbar interbody fusion,PLIF)治疗Ⅰ度退行性腰椎滑脱症的中期疗效。方法回顾性分析2014年6月至2016年6月采用Dynesys动态内固定治疗退行性腰椎Ⅰ度滑脱症患者68例(Dynesys组),男35例,女33例;年龄(55.3±7.5)岁(范围44~74岁);L38例,L452例,L58例;视觉模拟评分(visual analogue scale,VAS)(4.5±2.1)分。同期采用后路椎体间融合术治疗72例(PLIF组),男37例,女35例;年龄(56.8±7.2)岁(范围46~76岁);L39例,L453例,L510例;VAS评分为(4.4±2.3)分。比较两组患者的手术时间、术中出血量、术后引流量以及并发症,并对两组间的椎间活动度(range of motion,ROM)、稳定节段和上邻节段的椎间隙高度、邻近节段退变(adjacent segment degeneration,ASD)、Oswestry功能障碍指数(Oswestry disability index,ODI)、日本矫形外科协会(Japanese Orthopaedic Association,JOA)评分进行比较。结果两组患者均获得随访,其中Dynesys组随访时间(64.2±18.3)个月(范围50~74个月),PLIF组随访时间(65.2±15.5)个月(范围55~79个月)。Dynesys组手术时间[(120.5±21.0)min vs.(132.5±27.0)min;t=2.924,P=0.004)]、术中出血量[(312.5±80.7)ml vs.(352.5±84.5)ml;t=2.861,P=0.005]和术后引流量[(120.3±45.8)ml vs.(140.2±50.2)ml;t=2.446,P=0.016]均优于PLIF组,差异有统计学意义。两组患者术前稳定节段ROM、上邻节段ROM、稳定节段椎间隙高度、上邻节段椎间隙高度比较差异无统计学意义,术后5年稳定节段ROM(4.3°±1.6°vs.0,t=22.809,P<0.001)和上邻节段ROM(10.5°±2.1°vs.12.8°±2.2°;t=6.329,P<0.001)比较差异有统计学意义。术后5年,Dynesys组和PLIF组ODI评分分别为11.25%±8.12%和16.53%±9.23%,JOA评分分别为(22.60±2.20)分和(19.01±2.34)分,两组比较差异有统计学意义(t=3.585,9.340;均P<0.001);两组患者症状性ASD发生率(8.8%vs.16.7%)比较差异无统计学意义(χ^(2)=1.284,P=0.257);影像学ASD发生率(2.9%vs.13.9%)比较差异有统计学Objective To investigate the mid-term efficacy of Dynesys internal fixation and posterior lumbar interbody fusion(PLIF)in the treatment of grade I degenerative lumbar spondylolisthesis.Methods From June 2014 to June 2016,68 cases,in which 35 males and 33 females aged from 44-74(55.3±7.5),of grade I degenerative lumbar spondylolisthesis treated using Dynesys internal fixation were retrospectively analyzed.There were 8 cases of L3,52 cases of L4 and 8 cases of L5 with an average visual analogue scale(VAS)of 4.5±2.1.At the same time,72 patients were treated with posterior lumbar interbody fusion(PLIF).There were 37 males and 35 females aged from 46-76(56.8±7.2),with 9 cases of L3,53 cases of L4 and 10 cases of L5.The VAS of this group was 4.4±2.3.The operative time,intraoperative blood loss,postoperative drainage volume and complications were compared between the two groups.Range of motion(ROM),disc height of stable segment and upper adjacent segment,adjacent segment degeneration between the two groups were evaluated.ASD,Oswestry disability index(ODI)score and Japanese Orthopaedic Association(JOA)score were also compared between the two groups.Results The patients in both groups were followed up.The follow-up time of Dynesys group was 50-74 months,average 64.2±18.3 months,and the follow-up time of PLIF group was 55-79 months,average 65.2±15.5 months.The operation time[(120.5±21.0)min vs.(132.5±27.0)min,t=2.924,P=0.004],intraoperative bleeding[(312.5±80.7)ml vs.(352.5±84.5)ml,t=2.861,P=0.005]and postoperative drainage[(120.3±45.8)ml vs.(140.2±50.2)ml;t=2.446,P=0.016]in Dynesys group were significantly better than those in PLIF group.The differences were statistically significant.There was no significant difference in postoperative ROM of stable segment,ROM of upper segment,disc height of stable segment and adjacent segment between the two groups before operation.At 5 years postoperatively,there was statistically significant difference between the stable segment ROM(4.3°±1.6°vs.0;t=22.809;P<0.001)and th

关 键 词：腰椎 脊椎前移 内固定器 

分 类 号：R687.3[医药卫生—骨科学]