Dynesys动态内固定系统治疗非骨质疏松腰椎退变性疾病的临床疗效

Curative effect of Dynesys dynamic stabilization system on non-osteoporosis lumbar degenerative disease

目的评估Dynesys动态内固定系统治疗腰椎退变性疾病的临床疗效。方法回顾分析2012年1月至2015年1月采用Dynesys动态内固定系统治疗非骨质疏松腰椎退变性疾病患者44例,其中腰椎间盘突出症24例,腰椎管狭窄症20例。评估患者术前、术后1个月及末次随访的疼痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI),腰椎骨密度测量值T值≤-2.5排除出本研究病例。通过腰椎动力位X线片测量上述3个时间点手术节段及上位邻近节段的椎间活动度和椎间隙高度。结果全部病例随访13~36个月,平均(23±6)个月。术后1个月及末次随访时患者VAS评分和ODI指数均较术前明显改善(P<0.05),且2个时间点间差异无统计学意义(P>0.05);手术节段椎间活动度在术后1个月及末次随访时均较术前显著下降(P<0.05),手术节段椎间高度在术后有所增加,但3个时间点间差异均无统计学意义(P>0.05);上位邻近节段椎间活动度在术后均有所增加,但与术前相比差异无统计学意义(P>0.05),椎间高度在术后有所下降,但差异无统计学意义(P>0.05)。结论 Dynesys动态内固定系统能够很好地改善腰椎退变疾病患者的临床症状,早期的随访发现其可以保留手术节段的部分活动度,且不显著增加邻近节段的椎间活动度,但对邻近节段退变的预防效果需进一步长期随访观察。

Objective To evaluate the curative effect of Dynesys dynamic stabilization system for lumbar degenerative disease.Methods We retrospectively analyzed 44 patients suffering from lumbar degenerative disease who underwent lumbar spine stabilization with Dynesys from January 2012 to January 2015,including 24 patients with lumbar disc herniation and 20 patients with lumbar spinal stenosis.The clinical results were evaluated using the visual analogue scale（VAS）scores and Oswestry disability index（ODI）.The mean range of motion（ROM）and the disc space height in stabilized segments and upper adjacent segments were evaluated by the dynamic lateral X-rays.Results All the patients were followed up by（23±6）months in average（range,13-36 months）.The VAS and ODI scores both significantly improved at 1months and the final follow-up compared with the preoperative scores（P〈0.05）.Compared with preoperative value,the ROM of stabilized segments significantly decreased at 1months and the final follow-up（P〈0.05）,while the disc space height in stabilized segments increased at 1months and the final follow-up but with no statistical significance（P〉0.05）.The ROM of upper adjacent segments both increased at 1months and the final follow-up compared with the preoperative value but with no statistical significance（P〉0.05）,also there were no statistical significance in pre-and post-operative disc space height in upper adjacent segments（P〉0.05）.Conclusion Dynesys dynamic stabilization system can improve clinical outcomes of lumbar degenerative disease effectively.Short-term follow-up found it can remain the ROM of surgical segments without increasing the ROM of adjacent segments,but the ability to reduce adjacent segments degeneration needs long-term follow-up observation.