后路有限减压Dynesys动态固定治疗腰椎管狭窄症的早期临床疗效

Early efficacy of Dynesys dynamic stabilization after posterior limited decompression for lumbar spinal stenosis

目的探讨后路有限减压Dynesys动态固定治疗腰椎管狭窄症的早期临床效果。方法回顾性分析2012年3月至2014年3月中国人民解放军第86医院收治的采用后路有限减压联合Dynesys动态固定治疗的26例腰椎管狭窄症患者的临床资料,术前,术后7 d、6个月及末次随访时,应用视觉模拟量表（VAS）评分进行疼痛评估,采用Oswestry功能障碍指数（ODI）评价临床疗效,拍摄X线片测量手术节段椎间隙高度。结果手术时间90~150 min（平均105 min）、术中出血量100~350 m L（平均180 m L）;随访时间12~36个月（平均20个月）。术后7 d、6个月及末次随访时VAS评分、ODI均较术前明显改善（P〈0.05）,不同体位手术节段椎间隙高度与术前比较,差异均无统计学意义（P〉0.05）。未发现椎弓根钉松动、断裂,无钉绳系统、聚脂套管松动等并发症,未出现节段不稳或邻近节段退行性改变。结论后路有限椎管减压联合Dynesys系统动态固定治疗腰椎管狭窄症早期效果满意,能较好地维持手术节段椎间隙高度,预防椎间隙塌陷及腰椎不稳,但远期疗效尚需更长期的随访。

Objective To evaluate the short to midterm clinical results of Dynesys dynamic stabilization after posterior limited decompression for lumbar spinal stenosis. Methods Twenty-six patients with lumbar spinal stenosis who underwent posterior limited decompression combined with Dynesys dynamic stabilization from March 2012 to March 2014 in the 86 th Hospital of PLA, were included in this study, and their clinical data were analyzed retrospectively. At preoperation, as well as 7 days, 6 months after the operation, and the final follow-up,visual analogue scale（VAS） score and Oswestry disability index（ODI） were used to evaluate the pain status and lumbar function respectively, and the height of intervertebral space was measured with X-ray radiograph. Results The average operative time was 105 min（90-150 min）, and the average intraoperative estimate blood loss was180 m L（100-350 m L）. All patients were followed up for an average of 20 months（range, 12-36 months）. VAS score and ODI at different time-points after the operation had been improved significantly compared to the preoperative ones（P〈0.05）, while there were no statistical differences in the height of intervertebral space exmamined at different postures between preoperation and postoperation（P〉0.05）. No pedicle screw loosening or breakage was found, and there were no complications such as loosening of screw-rope system or polyester sleeve, also, no spinal instability or adjacent segment degeneration had happened during the follow up.Conclusions Posterior limited decompression combined with Dynesys dynamic stabilization is an effective surgical option for lumbar spinal stenosis which could maintain disc height, avoid disc interspace collapse and spinal instability and thus achieve satisfactory early clinical results; However, its long-term outcome needs to be further followed up.