Dynesys动态固定与经椎间孔椎间融合术治疗退变性L_5/S_1椎间盘突出症的疗效比较

Comparison of the Dynesys dynamicinternal system and transforminal lumbar interbody fusion for degenerative L_5/S_1 disc herniation

目的对比分析后路经椎弓根动态固定与经椎间孔椎间融合术(transforminal lumbar interbody fusion, TLIF)治疗退变性L_5/S_1椎间盘突出症的临床疗效。方法回顾性分析2011年1月至2015年1月我科收治的82例退变性L_5/S_1椎间盘突出症病人,所有病例均符合纳入标准。其中38例采用Dynesys动态内固定术(Dynesys组),44例采用经椎间孔椎间融合术(TLIF组)。比较两组术后1、3、6、12、24个月评估临床和影像学结果。结果末次随访时,两组Oswestry功能障碍指数(the Oswestry disability index,ODI)评分和疼痛视觉模拟评分(visual analogue score, VAS)均较术前显著改善,差异均有统计学意义(P均<0.05)。Dynesys组和TLIF组L_5/S_1的活动度(range of motion, ROM)分别从7.5°±2.6°降至5.2°±2.4°和7.2°±2.3°降至0°(P<0.05)。L_(4/5)的ROM分别从8.6°±2.8°增至10.1°±2.6°和8.4°±2.5°增至12.5°±2.9°(P<0.05)。Dynesys组和TLIF组发生L4/5邻近节段退变(adjacent segment degenelation, ASD)的例数分别为2例(5.25%)和11例(25.00%)。末次随访时,两组ROM和ASD比较,差异均有统计学意义(P均<0.05)。结论 Dynesys与TLIF治疗退变性L_5/S_1椎间盘突出症均能获得满意的临床疗效。与TLIF比较,Dynesys有利于保持ROM和减少ASD的发生,可作为退变性L_5/S_1椎间盘突出症的优选术式。

Objective To compare the clinical outcomes of dynamic internal system （dynesys） and transforminal lumbar interbody fusion （TLIF） for degenerative L5/S1 disc herniation. Methods From January 2011 to January 2015, 82 patients with degenerative L5/S1 disc herniation who entered into the inclusion criteria were retrospectively analyzed. Thirty-eight cases were treated with Dynesys dynamic internal fixation （Dynesys group）, and 44 cases were given TLIF （TLIF group）. Clinical and imaging results were compared in 1, 3, 6, 12 and 24 months after surgery. Results At the final follow-up, the Oswestry Disability Index （ODI） and visual analog scale （VAS） scores were significantly improved in both groups. The range of motion （ROM） of L5/S1 segment in Dynesys and TLIF groups decreased from 7.5° ± 2.6° to 5.2° ± 2.4° and from 7.2° ± 2.3° to 0° respectively （P〈0.05）. The ROM of L4/5 segment in two groups increased from 8.6°±2.8° to 10.1°±2.6° and from 8.4°±2.5° to 12.5°±2.9° respectively （P〈0.05）. L4/5 adjacent segment degeneration （ASD） occurred 2 cases （5.25%） in Dynesys group and 11 cases （25.00%） in TLIF group respectively. At the final follow-up, There were significant differences in ROM and ASD between two group （P〈0.05）. Conclusion Both Dynesys and TLIF have satisfactory clinical outcomes to degenerative L5/S1 disc herniation. Compared with TLIF, Dynesys partially prevents ROM loss and ASD complication. Dynesys can be used as a preferred procedure for degenerative L5/S1 disc herniation.