经Wiltse入路置入Dynesys系统治疗退变性腰椎管狭窄症

Degenerative lumbar spinal stenosis treated with decompression and Dynesys system via Wiltse approach

目的探讨经Wiltse入路置入Dynesys系统治疗退变性腰椎管狭窄症的手术效果。方法 2010年9月～2012年10月,采用Wiltse入路行椎板开窗减压＋Dynesys动态内固定系统治疗单节段退变性腰椎管狭窄共14例,男9例,女5例;年龄32～65岁,平均46.9岁;治疗节段L4/56例,L5/S18例。以术前、末次随访时疼痛视觉模拟评分（VAS）、Oswestry功能障碍指数评分（ODI）评估术后疗效。同时拍摄腰椎正侧位、过伸过屈位X线片,测量手术节段活动度（Range of motion,ROM）作为影像学研究指标。结果随访12～24个月,平均17.6个月。术前VAS评分（6.7±0.9）,末次随访为（2.1±0.7）;术前ODI评分（51.4±9.6）,术后末次随访为（11.1±4.1）;术后VAS、ODI评分明显改善,术前与末次随访的VAS、ODI评分差异有统计学意义（P〈0.05）。手术节段活动度术前为（9.1±2.4）°,术后末次随访时为（5.1±1.2）°,术前与末次随访时相比差异均有统计学意义（P〈0.05）。结论 Wiltse入路行椎板切除减压＋Dynesys动态内固定系统治疗单节段退变性腰椎管狭窄保留了腰椎生理曲度和固定节段的活动度,减少对椎旁肌的损伤,临床疗效满意。

Objective To evaluate the clinical efficacy of Dynesys system in treatment of degenerative lumbar spinal stenosis via Wiltse approach. Methods Fourteen patients with degenerative lumbar spinal stenosis treated in our institution by decompression combined with Dynesys system via Wiltse approach from September 2010 to October 2012, including9 male patients and 5 female patients. The age of patients is from 32 to 65（average age 46.9）. There 6 patients in L4/5,8patients in L5/S1. The visual analogue scale（VAS）, Oswestry disability index（ODI） and range of motion（ROM）were recorded preoperation and at the last follow-up. Results All patients were followed up for 12 to 24 months with the average time of 17.6 months.The VAS, ODI and ROM at preoperation and last follow-up postoperation was（6.7±0.9）,（2.1±0.7）;（51.4±9.6）,（11.1±4.1）;（9.1±2.4）°,（5.1±1.2）°. There was statistically significant differences at last follow-up postoperation compared with preoperation（P〈 0.05）. Conclusion Decompression and Dynesys system via Wiltse approach was a safe and effective surgery in the treatment of degenerative lumbar spinal stenosis, it can save the motion of lumbar, decrease the damage to the lumbar paraspinal muscles and have accurate clinical results.