髓核摘除Dynesys动态内固定系统固定治疗青壮年单节段腰椎间盘突出症的中长期疗效分析  

Analysis of mid-and long-term outcomes of discectomy and Dynesys dynamic stabilization system fixation in the treatment of single level lumbar disc herniation in young adults

作　　者：胡安南 周健 姜允琦 林红 李熙雷 周晓岗 董健 HU Annan;ZHOU Jian;JIANG Yunqi(Department of Orthopaedics,Zhongshan Hospital,Fudan University,Shanghai,200032,China)

机构地区：[1]复旦大学附属中山医院骨科,上海市200032

出　　处：《中国脊柱脊髓杂志》2023年第10期898-906,共9页Chinese Journal of Spine and Spinal Cord

摘　　要：目的:观察髓核摘除Dynesys动态内固定系统固定治疗青壮年单节段腰椎间盘突出症(lumbar disc heniation,LDH)的中长期疗效。方法:回顾性分析2010年12月~2014年8月于我院骨科手术治疗且资料完整的62例青壮年单节段LDH病患者的临床资料,其中31例采用髓核摘除Dynesys动态内固定系统固定术治疗(Dynesys组),31例采用单纯髓核摘除术治疗(对照组),两组患者的年龄、性别比、体重指数、病程、合并基础病、吸烟史、手术节段等基线数据无显著性差异。收集两组患者手术相关资料及并发症,比较两组术前及末次随访时的疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)、手术节段和近端邻近节段的椎间盘高度(disc height,DH)、椎间活动度(range of motion,ROM)和椎间盘改良Pfirrmann分级。结果:对照组手术时间和术后住院时间更短、术中出血更少(P<0.05)。Dynesys组3例、对照组1例术中发现硬膜撕裂,予以仔细缝合修补,术后均未发生脑脊液漏;Dynesys组和对照组各有1例患者住院期间因发热使用抗生素治疗,均排除手术部位感染。对照组1例患者术后1个月因切口渗液、愈合不良再入院行清创术。Dynesys组随访72~109个月(91.8±11.1个月);对照组随访72~116个月(93.7±12.7个月)。末次随访时两组患者腰痛和腿痛VAS评分、ODI均较术前显著性改善(P<0.05),两组同时间点比较无显著性差异(P>0.05);两组手术节段DH均较术前显著性下降(P<0.05),对照组下降比Dynesys组更显著(P<0.05);两组近端邻近节段DH较术前均无显著性变化。Dynesys组手术节段ROM在末次随访时得到部分保留(2.7°±2.1°),但较术前显著性降低(P<0.05);近端邻近节段ROM均较术前显著性增加(P<0.05),但与对照组比较无显著性差异。末次随访时两组手术节段和近端邻近节段的椎间盘改良Pfirrmann分级均较术前进展(P<0.05),对照组手术�Objectives:To observe the mid-and long-term outcomes of discectomy and Dynesys dynamic stabilization system fixation in the treatment of single level lumbar disc herniation(LDH)in young adults.Methods:A retrospective analysis was performed on 62 young adult patients with single level LDH who underwent orthopedic surgery in the Department of Orthopaedics in our hospital between December 2010 and August 2014 and with complete data.Among the patients,31 cases were treated with discectomy and Dynesys dynamic stabilization system fixation(Dynesys group),and the rest 31 were treated with discectomy alone(control group).There were no significant differences in baseline data between the two groups such as age,gender ratio,body mass index(BMI),duration of disease,comorbidities,smoking history,and surgical segments.Surgical-related data and complications were collected for both groups of patients.The visual analogue scale(VAS),Oswestry disability index(ODI),and disc height(DH),range of motion(ROM)and modified Pfirrmann grade of the surgical and proximal adjacent segment were compared between the two groups before surgery and at the final follow-up.Results:The control group had shorter operative time and postoperative hospital stay,and less intraoperative blood loss(P<0.05).Three cases in the Dynesys group and 1 case in the control group were found to have dural tears during operation,which were all carefully sutured and repaired,and no cerebrospinal fluid leakage occurred after surgery;One patient in each group had fever during hospitalization,who were both treated with antibiotics and ruled out of surgical site infection.One patient in the control group was re-admitted for debridement due to incision exudation and poor healing one month after surgery.The follow-up time was 72-109 months(91.8±11.1 months)in the Dynesys group and 72-116 months(93.7±12.7 months)in the control group.The VAS scores of low back pain and leg pain and ODI in both groups were significantly improved at the final follow-up compared with those befo

关 键 词：腰椎间盘突出症 Dynesys动态内固定系统 青壮年 髓核摘除术 

分 类 号：R681.5[医药卫生—骨科学] R687.3[医药卫生—外科学]