Dynesys动态内固定与融合术治疗腰椎退变疾病的对比研究

Comparisons of Dynesys stabilization and posterior lumbar interbody fusion for lumbar degenerative disease

目的 比较Dynesys动态内固定与腰椎后路椎间融合术（posterior lumbar interbody fusion,PLIF）治疗腰椎退变疾病的临床疗效和影像学结果.方法回顾分析2008年7月-2011年3月采用Dynesys 动态固定治疗且随访时间＞2年的腰椎退变患者46例（Dynesys组）,以同期行PLIF的50例患者作为对照（PLIF组）.记录2组手术前后Oswestry 功能障碍指数（Oswestry disability index,ODI）和疼痛视觉模拟量表（visual analogue scale,VAS） 评分,摄腰椎正侧位和前屈后伸位X线片,测量手术节段椎间高度、活动度（range of motion,ROM）以及近侧邻近节段的椎间ROM,评估2组影像学和症状学邻近节段退变的发生情况.结果 2组患者术前资料差异无统计学意义,末次随访时的ODI及VAS评分均较术前明显改善（P＜0.05）,组间差异无统计学意义（P＞0.05）.末次随访时Dynesys组手术节段椎间高度较术前轻度升高（P＞0.05）,而PLIF组显著升高（P＜0.05）且大于Dynesys组,组间差异有统计学意义（P＜0.05）.Dynesys组手术节段ROM由术前的7.1°降至末次随访时的4.9°（P＜0.05）,而PLIF组手术节段ROM由术前的7.3°降至末次随访时的0°（P＜0.05）.2组近侧邻近节段椎间高度变化差异无统计学意义（P＞0.05）,ROM在末次随访时均较术前有所增加（P＜0.05）,且PLIF组大于Dynesys组（P＜0.05）.Dynesys组有6例患者出现影像学邻近节段退变,PLIF组患者有15例出现影像学邻近节段退变,差异有统计学意义（P＜0.05）,仅PLIF组有1例出现症状学邻近节段退变,行二次手术治疗.结论 Dynesys动态内固定与融合术均获得良好临床疗效.与融合术相比,Dynesys动态内固定能够保留手术节段部分ROM,邻近节段椎间ROM的增幅及邻近节段退变发生数均较低.

Objective To compare the clinical and radiographic outcomes of Dynesys stabilization and posterior lumbar i nterbody fusion（PLIF） in the treatment of lumbar degenerative disease. Methods A total of 46 patients （ Dynesys group） treated by lumbar spine stabilization with Dynesys for lumbar degenerative disease were retrospectively analyzed from July 2008 to March 2011. The follow-up period was more than 24 months. Other 50 patients （PLIF group） treated by PLIF for lumbar degenerative disease at the same stage were retrospectively matched as control group. Clinical outcomes were evaluated using Oswestry disability index （ODI） and visual analogue scale （VAS）. Radiographic evaluations included the disc height and range of motion （ ROM ） of stabilized segments and the upper adjacent segments by lumbar neutral, flexion, and extension X-ray. The occurrence of radiographic and symptoms of adjacent segment degeneration （ASD） was evaluated between the 2 groups. Results The ODI and VAS scores were both significantly improved in the 2 groups at 3 months and the final follow-up （ P 〈 0.05 ）, but the difference of the improvement between the 2 groups was statistically significant （ P 〉 0.05 ）. At the final follow-up, the dices height of stabilized segments in the Dynesys group increased slightly （ P 〉 0.05 ）, while the increase wassignificant in the PLIF group（P 〈 0. 05 ）, the difference between the 2 groups was significant （P 〈 0. 05 ）. The ROM of stabi- lized segments in Dynesys group decreased from 7.1 ° to 4.9 ° （ P 〈 0.05 ） , while that of in the PLIF group decreased from 7.3° to 0 ° （ P 〈0. 05 ） at the final follow-up. The height of upper segment in both groups did not decrease significantly （ P 〉 0.05 ）. The ROM of the upper segment increased significantly in both groups at the final follow-up（ P 〈0.05 ）, the change was more significant in the PLIF group than that of in the Dynesys group （ P 〈 0. 05 ）. There were 6 cases of radiographic ASD in the Dynesys group and 15 cases in the PLIF group, the difference was significant（ P 〈 0.05 ）. Only 1 case with ASD symptoms occurred in the PLIF group, and the patients received a second operation. Conclusion Both Dynesys and PLIF can improve the clinical outcomes for lumbar degenerative disease. Compared to PLIF, Dynesys stabilization partially can preserve the ROM of stabilized segments, and limit the hypermobility in the upper adjacent segment, and may prevent the occurrenc, e of ASD.