Dynesys系统治疗腰椎退行性疾病对邻近节段的影响

Dynesys dynamic neutralization system for the treatment of lumbar degenerative disease and the effect on the adjacent segment

背景:大多数文献报道Dynesys动态中和稳定系统在治疗腰椎退行性疾病中取得了较好的临床疗效,但能否防止邻近节段退行性病变发生仍然存在争议。目的:观察Dynesys系统治疗腰椎退行性疾病的临床疗效及对邻近节段的影响。方法:自2009年3月至2012年10月收治20例腰椎退行性疾病患者,均采用手术减压加Dynesys系统动态固定治疗。Dynesys动态系统由Zimmer公司提供,由钛合金椎弓根螺钉、聚氨基甲酸乙酯套管和聚对苯二甲酸乙酯绳索组成。以目测类比评分、Oswestry功能障碍指数进行临床疗效评价;依照Woodend评分评估邻近椎间盘退变程度;治疗有效率按Macnab标准评价。结果与结论:20例患者全部获得随访,时间22-31个月。临床疗效按Macnab标准评价:优11例,良6例,可3例,优良率达85%。末次随访时,患者目测类比评分显著低于治疗前[(2.25±1.67)分,(8.29±1.50)分,P<0.01];Oswestry功能障碍指数也显著低于治疗前[(15.38±3.42)分,(65.46±10.33)分,P<0.01]。邻近节段椎间盘退变的Woodend评分治疗前平均为1.33分,末次随访时平均为1.60分,差异无显著性意义(P>0.05)。提示Dynesys系统动态固定治疗腰椎退变性疾病早期疗效确切,长期疗效及其防止或延缓邻近节段退变的作用尚需多中心随机对照临床试验来证实。

BACKGROUND：Numerous studies show Dynesys dynamic neutralization system has achieved good clinical efficacy in the treatment of lumbar degenerative disease. But whether Dynesys dynamic neutralization system can prevent the adjacent segment degenerative disease is stil controversial. OBJECTIVE：To investigate the efficacy of the Dynesys system for the treatment of lumbar degenerative disease and impact on adjacent segments. METHODS：From March 2009 to October 2012, 20 consecutive patients with lumbar degenerative disease were included in this study. Al the patients were treated with surgical decompression plus Dynesys system dynamic fixation. The Dynesys system was provided by Zimmer Company, and composed with titanium al oy pedicle screws, polyurethane sleeve and polyethylene terephthalate rope. Clinical outcomes were evaluated using visual analogue scale and Oswestry disability index before and after operation. The degeneration of the adjacent segment was evaluated according to Woodend score;the treatment efficiency was assessed with Macnab criteria. RESULTS AND CONCLUSION：Al the 20 patients were fol owed-up for 22-31 months. According to Macnab criteria, excel ent in 11 cases, good in six cases, fair in three cases, and the excel ent and good rate was 83%. The visual analogue scale score was decreased from preoperative （8.29±1.50） to postoperative （2.25±1.67） （P〈0.01）, and the Oswestry disability index score was improved from （65.46±10.33） to （15.38±3.42） （P〈0.01）. Mean Woodend score of adjacent segment degeneration was increased from 1.33 preoperatively to 1.60 postoperatively, and the difference was significant （P〉0.05）. This study shows Dynesys system is safe and effective in the treatment of lumbar degenerative diseases and multi-center randomized control ed clinical trials are needed to identify whether it can reduce or prevent the occurrence of disc degeneration of adjacent segments.