Dynesys融合和非融合固定混搭手术治疗腰椎退行性疾病的中长期疗效  

Mid- and long-term outcomes of hybrid surgery combined Dynesys fusion and non-fusion stabilization in the treatment of degenerative lumbar diseases

作　　者：胡安南 陈帆成 江立波 姜允琦 林红 李熙雷 周晓岗 董健 Hu Annan;Chen Fancheng;Jiang Libo;Jiang Yunqi;Lin Hong;Li Xilei;Zhou Xiaogang;Dong Jian(Department of Orthopaedic Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院骨科,上海200032

出　　处：《中华骨科杂志》2021年第17期1237-1246,共10页Chinese Journal of Orthopaedics

基　　金：上海人才发展基金(2020067)。

摘　　要：目的评估Dynesys混搭手术(部分节段采用Dynesys非融合固定,另部分节段采用Dynesys联合椎间融合器融合固定)治疗腰椎退行性疾病(lumbar degenerative disease,LDD)的中长期疗效。方法回顾性分析2011年5月至2016年9月期间27例LDD接受Dynesys融合固定和非融合固定混搭手术治疗且随访完整的病历资料(混搭组)。男8例,女19例;年龄(59.1±11.9)岁(范围23~78岁)。腰椎管狭窄症13例,腰椎间盘突出症14例;合并腰椎动力位不稳4例,腰椎滑脱7例。双节段病变15例,L3~L59例、L4~S16例;三节段病变11例,L3~S17例、L2~L54例;四节段病变1例,L2~S11例。均采用后路正中切口,双侧椎弓根螺钉植入,在融合节段加植入椎间融合器植骨融合。以同期27例接受经椎间孔腰椎椎间融合术(transforaminal lumbar interbody fusion,TLIF)的病例作为对照。临床指标包括腰痛和下肢痛的疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)。影像学指标包括融合率、固定节段和头侧邻近节段的椎间隙高度(disc hight,DH)、非融合节段和头侧邻近节段的椎间活动度(range of motion,ROM)。记录并发症发生情况。结果混搭组和融合组随访时间分别为(83.8±20.9)个月(范围48~112个月)和(87.3±16.2)个月(范围53~114个月)。两组患者基线资料(随访时间、年龄、性别、手术节段、疾病诊断)的差异均无统计学意义。混搭组手术时间为(183.0±27.8)min,术中出血量为(301.9±178.9)ml,明显少于融合组(t=2.337,P=0.023;t=2.706,P=0.01)。两组患者末次随访腰痛VAS评分(t=12.164,P<0.001)、下肢痛VAS评分(t=20.703,P<0.001)和ODI(t=22.827,P<0.001)均较术前有明显改善。混搭组共32个节段接受TLIF+Dynesys固定,35个节段接受Dynesys非融合固定,术后1年28个融合节段(87.5%)获得骨性融合。融合组共67个融合节段,术后1年融合率为85.1%。混搭组末次随访时非融合固定节段DH较术前有�Objective To evaluate the mid-and long-term outcomes of Dynesys hybrid surgery(in some segments act as a non-fusion device,in other segments act as an alternative of rigid fixation in combination with interbody fusion)in the treatment of multi-segmental lumbar degenerative disease(LDD).Methods The data of 27 patients who received Dynesys hybrid surgery(hybrid group)for the treatment of LDD from May 2011 to September 2016 and completed the follow-up were retrospectively analyzed.Among them,there were 8 males and 19 females;their average age was 59.1±11.9 years(23-78 years).Main diagnosis:13 cases of lumbar spinal stenosis,14 cases of lumbar disc herniation;4 cases of combined lumbar dynamic position instability,7 cases of combined lumbar spondylolisthesis.There were 15 cases of two-segment disease,11 cases of three-segment disease,and 1 case of four-segment disease.Segments distribution:9 cases of L3-L5,6 cases of L4-S1,7 cases of L 3-S1,4 cases of L2-L5,and 1 case of L2-S1.Midline incision was used to exposure,followed by bilateral pedicle screws implantation,and interbody fusion cage with bone grafting were performed at the fusion level.Twenty-seven patients who underwent TLIF+rigid internal fixation during the same period were included as the control group.Clinical outcomes were measured by visual analog scale(VAS)for low back pain and leg pain,and Oswestry disability index(ODI).Radiological outcomes included fusion rate,intervertebral disc height(DH)of surgical segments and the proximal adjacent segment,range of motion(ROM)of non-fusion segments and the proximal adjacent segment.At the same time,the occurrence of complications was observed.Results Patients of Hybrid group and control group were followed up for an average of 83.8±20.9 months(48-112 months)and 87.3±16.2 months(53-114 months),respectively.Baseline data of the two groups(average follow-up time,age,gender,surgical level,diagnosis)showed no significant difference.The operation time(183.0±27.8 min)and intraoperative blood loss(301.9±178.9 ml)in

关 键 词：腰椎 椎间盘退行性变 脊柱融合术 内固定器 

分 类 号：R687.3[医药卫生—骨科学]