两种内固定治疗腰椎退行性疾病的临床效果对比

Comparison of clinical effects of two kinds of internal fixation on lumbar degenerative diseases

目的比较非融合Dynesys动态稳定系统内固定与融合内固定治疗腰椎退变性疾病的临床疗效。方法选择2009年9月至2012年3月腰椎退变性疾病患者41例，依据手术方案分为Dynesys组19例和融合组22例，随访30～36个月，比较两组手术指标及治疗前后评估指标水平。结果Dynesys组手术时间（103．1±22．8）min、出血量（320．7±124．4）ml及住院时间（10．2±2．8）d均优于融合组，差异有统计学意义（P〈0．05）。两组视觉模拟评分、Oswestry功能障碍指数术后末次随访比较差异未见统计学意义（P〉0．05）。两组手术固定节段ROM末次随访与术前比较均减小，差异有统计学意义（P〈0．05），但末次随访Dynesys组比融合组增大，融合组手术固定节段活动度均完全丧失；融合组末次随访相邻节段活动度增加，差异有统计学意义（P〈0．05），末次随访相邻节段活动度Dynesys组小于融合组，差异有统计学意义（P〈0．05）。结论Dynesys动态稳定系统内固定治疗腰椎退行性疾病的初中期疗效比较确切。远期疗效还需大样本进一步研究。

Objective To compare the clinical effects of dynesys stabilization system and fusion internal fixation on lumbar degenerative diseases. Methods From September 2009 to March 2012, 41 patients with lumbar degenerative disease were selected, and divided into the Dynesys group （19 cases） and the fusion group （22 cases） according to the operation methods. Followed up for 30 to 36 months, operation indicators and evaluation index of the two groups before and after treatment were compared. Results The operation time（ 103. 1 ± 22. 8 ） min, bleeding volume （320. 7 ± 124. 4 ） ml and length of hospital stay （ 10. 2 ±2. 8）d in the Dynesys group were better than those in the fusion group, the differences were significant （P 〈 0. 05）. The differences of VAS and ODI scores after the last follow-up of the two groups were not significant（P 〉0. 05）. Operation segment ROM of the two groups at last follow-up was lower than before operation, the differences were significant （P 〈 0. 05）. At the last follow-up, the Dynesys group was better than the fusion group, operation segment ROM of fusion group was completely lost; adjacent segment ROM of fusion group was increased at last follow-up, the differences were significant （P 〈 0. 05 ）. At the last follow-up, adjacent segment ROM of Dynesys group was less than that of fusion group, the difference was significant （P 〈 0. 05 ）. Conclusions Dynesys dynamic stabilization system internal fixation for the treatment of lumbar degenerative diseases of middle period of efficacy is more accurate, but long-term effect of large samples for further studies is needed.