Dynesys治疗腰椎退变和不稳(附13例报告)

Application of Dynesys for degeneration and instability of lumbar:a report of 13 cases

[目的]探讨动力性固定器Dynesys治疗腰椎退变和不稳的固定原理、适应证和初步疗效。[方法]作者于2004年在瑞士Basel大学骨科进修学习期间,随访Dynesys治疗12个月以上的13例患者,平均随访16个月(范围12～25个月);年龄58～78岁,平均65岁;所有患者均有保守治疗难以治愈的腰痛或腰腿痛6个月以上,术前Oswestry评分50～69分,平均58分;Ⅰ度退变性腰椎滑脱1例,腰椎管狭窄症6例,腰椎间盘突出症或伴节段性不稳3例,退变性脊椎关节病3例。[结果]Oswestry评分至最后随访改善到24～53分,平均31.3分;参照Nakai标准,优5例,良5例,可2例,差1例;无螺钉弯曲或断裂。差者1例术后1年再次行椎管探查、改行强直性固定融合。[结论]Dynesys是治疗腰椎退变和轻度不稳的一种有效的非融合性、动力性固定系统。

[ Objective] To study the stabilization mechanism, indications and primary treatment results of dynamic stabilization system-Dynesys. [ Method] Thirteen cases were followed up for a minimum of 12 months with an average of 16 months （ranged, 12 -25 months）. The mean age was 57 -73 years with an average of 68. All the patients bad got low-back pain and/ or leg pain resistant to conservative treatments lasting over 6 months. Oswestry scores were 50 - 73 with an average of 60. 2 preoperatively. The pathologies treated were degenerative spondylolisthesis in 1 case, spinal stenosis in 6 cases, disc herniation or accompanied by segmental instability in 3 cases, osteochondrosis and facet joint osteoarthritis in 3 cases. [ Result] The Oswestry scores were 24-53 with an average of 31.3 at the final follow up. According to Nakai＇s criteria, excellent and good in five, passable in two and poor in one were found. There was no bending of broken of screws. One case for poor was re-operated one year later, in whom Dynesys was replaced by rigid stabilization and grafting. [ Conclusion] Dynesys is an effective nonfusion and dynamic stabilization system for degeneration and light instability of lumbar.