后路减压结合动态中和系统治疗腰椎退行性疾病的疗效分析

Efficacy of posterior decompression and dynamic neutralization system for treatment of lumbar ;degenerative disease

目的：分析后路减压结合动态中和系统（Dynesys）治疗腰椎退行性疾病的临床疗效。方法2011年5月至2013年9月共97例腰椎退行性疾病患者，行后路椎管减压联合Dynesys椎弓根内固定手术，其中男性54例，女性43例，年龄29-56岁，中位年龄38岁。单节段63例，双节段34例。采用Oswestry功能障碍指数（ODI）、疼痛视觉模拟量表（VAS ）和日本矫形外科学会（JOA）评分评价临床疗效。根据术前、末次随访时的影像学资料观察手术节段椎间隙高度变化、手术及相邻节段椎体的活动度变化、椎间盘退行性改变。腰椎正侧位、动力位X线片进行椎间角度测量，并计算椎间角度位移（ROM）。利用腰椎MRI计算手术节段椎间盘平均标准椎间盘信号（calibrated disc signal，CDS）。评价椎间盘再修复情况。结果随访时间24-52个月，平均（31.21±7.63）个月。未发生严重并发症，无复发翻修病例，有3例患者术后3月内出现下腰痛加重，经保守治疗后症状缓解。术后末次随访VAS评分及ODI均较术前显著降低（P〈0.01），JOA评分则显著升高（P〈0.01）。手术节段的ROM显著减少（P〈0.05），但手术相邻节段的术前ROM与末次随访时的ROM比较却差异无统计学意义（P〉0.05）。其中53名患者术后末次随访复查腰椎MRI，平均年龄（37.83±11.56）岁，共66个节段，手术节段平均CDS由术前（39.51±10.76）%改善至（47.35±13.61）%，差异有统计学意义（P〈0.01）。结论后路减压结合动态中和稳定系统治疗腰椎退行性疾病临床疗效确切，Dynesys系统能保持手术节段的稳定性，又能保留被固定节段的活动性，实现了动态中和稳定，且对邻近节段的稳定性无明显影响。Dynesys非融合术后部分残留椎间盘出现再水化，表明其可能具有促进退变椎间盘修复再生的作用，但由于观察指标的局限性，尚需进一步长期随访研究证实。

Objective To analyze the clinical efficacy of posterior decompression and dynamic neutralization system （Dynesys） for treatment of lumbar degenerative disease. Methods A total of 97 patients with lumbar degenerative diseases,who underwent posterior spinal decompression and Dynesys fixation of vertebral pedicle between May 2011 and September 2013 were included in the study,including 54 males and 43 females（aged 29 to 56 years old,median age 38 years old;63 cases of single segment,34 cases of double segments,Using Oswestry disability index（ODI）,visual analogue scale（VAS）and Japan Orthopaedic Society （JOA） scoring to evaluate the clinical efficacy. According to the imaging data of the preoperative and the last follow-up,the changes of the intervertebral height of surgical segments,vertebral range of motion （ROM） of surgical and adjacent segments,and intervertebral disc degeneration were determined. The intervertebral angles of anterior-posterior lateral and dynamic lumbar X-ray were measured ,＆amp;nbsp;and the ROM of the intervertebral angles was calculated. The average calibrated disc signal（CDS）of surgical segments was calculated by lumbar magnetic resonance imaging （MRI）. The repaired condition of intervertebral disc was evaluated. Results The length of follow-up was 24 to 52 months,and the median length of follow-up was （31.21 ± 7.63） months. There were no serious complications and recurrence of repaired cases. Low back pain was aggravated in 3 patients at 3 months after the operation,and was relieved after conservative treatment. The VAS score and ODI of the last follow-up after the operation were significantly reduced than those before the operation （P〈0.01）,whereas the JOA score was significantly increased（P〈0.01）. The ROM of the surgical segment was significantly reduced（P〈0.05）. There was no statistical difference in the ROM of surgical and adjacent segments between the preoperative and the last follow-up（P〉0.05）. Fifty-three patients received lumbar MRI reexamination at the last preoperative follow-up[mean age（37.83±11.56）years old,a total of 66 segments],and the average CDS of surgical segments was improved from 39.51%± 10.76%to 47.35%± 13.61%（P〈0.01）. Conclusion The length of follow-up was 24 to 52 months,and the median length of follow-up was（31.21 ± 7.63）months. There were no serious complications and recurrence of repaired cases. Low back pain was aggravated in 3 patients at 3 months after the operation,and was relieved after conservative treatment. The VAS score and ODI of the last follow-up after the operation were significantly reduced than those before the operation （P〈0.01）,whereas the JOA score was significantly increased（P〈0.01）. The ROM of the surgical segment was significantly reduced（P〈0.05）. There was no statistical difference in the ROM of surgical and adjacent segments between the preoperative and the last follow-up（P〉0.05）. Fifty-three patients received lumbar MRI reexamination at the last preoperative follow-up[mean age（37.83 ± 11.56）years old,a total of 66 segments],and the average CDS of surgical segments was improved from 39.51%±10.76%to 47.35%±13.61%（P〈0.01）.