Dynesys弹性内固定系统治疗腰椎退变性疾病的效果评价

Efficacy of dynesys spinal system for spinal degenerative disease

目的通过分析应用Dynesys非融合内固定系统治疗腰椎退行性疾病的临床结果,总结Dynesys非融合内固定的适应证和临床应用价值。通过比较腰椎融合内固定的病例得出Dynesys非融合内固定的优缺点。方法选择2008—2015年新疆维吾尔自治区人民医院收治的40例腰椎退行性病变的患者,男性28例,女性12例,年龄33~58岁,平均41岁。术前完善详细的影像学检查包括腰椎正侧位X线片,腰椎动力位X线片,腰椎椎体加间隙平扫+二维重建CT,腰椎核磁检查及腰椎功能评分,手术方式采用后路相应病灶节段Dynesys非融合椎弓根内固定术。采用JOA和ODI评分标准进行疗效评价。对患者术前及末次随访神经功能与自觉症状进行评估并计算改善率,对所得结果进行统计学分析。结果本研究中40例患者得到12~90个月随访,平均52个月。末次随访时JOA评分优良率80.0%,ODI指数从术前(42.864±5.528)下降到术后末次随访时的(9.438±2.649),疼痛评分VAS也有明显下降,差异有统计学意义(P<0.05)。术后随访中患者均未出现椎间隙感染、腰椎失稳及内固定失效等并发症。结论 Dynesys非融合椎弓根内固定术是治疗腰椎退行性疾患的一种有效的方法。如适应征选择正确则具有防止相邻节段椎间盘退变的显著优点,突显保留腰椎生理性运动功能的作用,改善腰椎失稳的效果确切,在改善腰腿疼症状的治疗效果上与传统的腰椎后路融合手术效果相当,没有明显差异。

Objective To assess the indications, clinical application value and advantages of Dynesys non-fusion pedicle screw-based stabilization system in the treatment of lumbar degenerative disc disease. Methods Total 40 eases of lumbar degenerative disc disease （ male 28, female 22, with an average age of 41 ） in our hospital between 2008 and 2015 were re- viewed retrospectively. The preoperative imaging examinations included lateral and dynamic X-rays of the lumbar spine, plain scanning and 3D reconstruction for vertebrae and disc space, MRI functional score for lumbar vertebra. Posterolateral approach Dynesys non-fusion pedicle screw-based stabilization system was performed in all eases. The Japanese Orthopae- dic Association（JOA） and Oswestry Disability Index （ODI） score were employed to assess the clinical efficacy and im- provement rate before and after the operation. The results were put into statistical analysis. Results Fourty patients were followed up for 12 to 90 months with an average of 52. At the final follow-up, the excellent and good rate by JOA score was 80.0% , and ODI decreased from 42. 864 _＋ 5. 528 to 9. 438 _＋ 2. 649, VAS for pain also decreased obviously, the difference was statistically significant（ P 〈 0.05 ）. There was no intelvertebral space infection, lumbar intervertcbral instability and failure in internal fixation during the follow up. Conclusion Dynesys system is an effective method for lumbar spine de- generation in preventing adjacent disc degeneration, reserving lumbar physiological movement and improving lumbar insta- bility, shows similar effect in improving the symptoms of low back pain with conventional posterior lumbar fusion surgery.