动态中和稳定系统治疗腰椎退行性疾病的临床疗效及邻近节段间盘退变的影像学变化

The Clinical Efficacy and Radiologic Changes at Adjacent Segment Disc Degeneration by Dynesys System for the Treatment of Lumbar Degenerative Disease

目的 研究动态中和稳定系统（dynamic neutralization system,Dynesys）治疗腰椎退行性疾病的临床疗效及邻近节段椎间盘退变的影像学变化.方法 34例201 1年1月至2012年2月收治的腰椎退变性疾病患者均采用减压及Dynesys系统内固定治疗,应用疼痛视觉模拟评分（VAS）及Oswestry功能障碍指数（ODI）进行临床疗效评估;依照Woodend评分评估邻近节段椎间盘退变程度;运用Macnab标准进行治疗有效率评价.结果 术后随访24～ 33个月,平均随访28个月.临床疗效按Macnab标准评价：优17例,良13例,可4例,优良率达88％.术后各随访时间点腰痛、腿痛VAS评分均较术前明显改善（P＜0.05）;而术后各随访时间点之间腰痛、腿痛VAS评分比较差异无统计学意义（P＞0.05）.术后各随访时间点ODI评分均较术前明显降低（P＜0.05）;术后3个月时的ODI评分与术后12、24月ODI评分比较差异有统计学意义（P＜0.05）.末次随访时近端和远端相邻节段椎间盘退变的Woodend评分较术前评分无明显改善（P＞0.05）.结论 Dynesys治疗腰椎退行性病变的近期临床疗效肯定.对邻近节段椎间盘退变的短期影响不明显,尚需进一步长期随访观察.

Objective To study the clinical efficacy and radiologic changes at adjacent segment disc degener- ation by dynamic neutralization system （Dynesys） for lumbar degenerative disease. Methods From Jan 2011 to Feb 2012, 34 patients with lumbar spine degenerative disease were enrolled in this study. All the patients were treated with decompression plus dynamic neutralization system internal fixation. Clinical outcomes wereevaluated using visual analogue scale （VAS） and Oswestry disability index （ODI） before and postoperation last followup. The degeneration of the adjacent segment disc was evaluated according to Woodend score; the treatment efficiency was evaluated by Macnab criteria. Results All patients were followed -up for 24 ~ 33 months postoperation, the mean 28 months. Accordingto Macnab criteria, excellent in 17 cases, good in 13 cases, fair in 4 cases, and the excellent and good rate was 88%. The VAS scores of back and leg pain at each followup time postoperative were significantly improved than that preoperative （ P 〈 O. 05 ） , while the score showed no significantly different between each followup time postoperative（ P 〉 0.05 ）. The ODI scores at each followup time postoperative were significantly improved than that preoperative （ P 〈 0.05 ）, the score at 3 month postoperative was significantly different from those at 12 months and 24 months postoperative （P 〈 0. 05 ）. The mean Woodend score at final followup postoperative was not significantly improved than preopera- tive at the cranial adjacent segment （P 〉 0.05 ）. The mean Woodend score at final followup postoperative was not significantly improved than preoperative at the caudal adjacent segment （P 〉 0.05 ）. Conclusion Dyne- sys system is effective in clinical outcome in the treatment of lumbar degenerative diseases. Dynesys for the short - term impact of adjacent segment disc degeneration is still not clear and the results need to be further long - term follow - up.