经Wiltse入路置入Dynesys内固定系统治疗单节段腰椎间盘突出症的疗效观察

Observation of curative effect of Dynesys internal fixation through Wiltse approach in the treatment of single-segment lumbar disc herniation

目的探讨经Wiltse入路置入Dynesys内固定系统治疗单节段腰椎间盘突出症的疗效。方法单节段腰椎间盘突出症患者102例,按照手术方法不同分为对照组(54例)和观察组(48例),对照组采取腰椎后路锥间融合术治疗,观察组采用经Wiltse入路置入Dynesys内固定系统治疗,比较两组围术期相关指标、视觉模拟疼痛(VAS)评分、Oswestry功能障碍指数(ODI)、椎间活动度(ROM)。结果观察组手术时间、术中出血量低于对照组(P<0.05);两组术前腰部、下肢的VAS评分比较,差异无统计学意义(P>0.05),术后1周观察组VAS评分低于对照组(P<0.05),术后6月VAS评分均下降,两组间比较差异无统计学意义(P>0.05);两组术前手术节段及邻近的上下节段的ROM比较,差异无统计学意义(P>0.05),术后手术节段ROM均降低,对照组低于观察组,手术邻近节段的上下节段ROM均增加,观察组低于对照组(P<0.05);两组术前ODI评分比较,差异无统计学意义(P>0.05),术后6月ODI评分均下降,观察组低于对照组(P<0.05)。结论经Wiltse入路置入Dynesys内固定系统具有创伤小、术后恢复快等优点,较传统的腰椎后路锥间融合术相比,能够保留手术节段的ROM,降低疼痛感觉,减少邻近节段的过度活动,在治疗单节段腰椎间盘突出症具有独特优势,值得临床推广。

Objective To explore the effects of Dynesys internal fixation through Wiltse approach in the treatment of singlesegment lumbar disc herniation.Methods A total of 102 patients with single-segment lumbar disc herniation were divided into control group and observation group according to surgical method.The control group(n=54)were treated with posterior inter-body fusion,and the observation group(n=48)were treated with Dynesys internal fixation through Wiltse approach.The related perioperative indicators,pain visual analogue scale(VAS)score,Oswestry Dysfunction Index(ODI)and intervertebral range of motion(ROM)were compared between the two groups.Results The operation time and intraoperative blood loss of the observation group were significantly shorter or less than those of the control group(P<0.05).There were no significant differences in VAS scores of the waist and lower limbs between the two groups before surgery(P>0.05).VAS score of the observation group was significantly lower than that of the control group after1 week of surgery(P<0.05).VAS scores of both groups were decreased after 6 months of surgery,but no significant difference was found between the two groups(P>0.05).There was no significant difference in ROM of the surgical segment or the adjacent upper and lower segments between the two groups before surgery(P>0.05).ROM of the surgical segments was reduced after surgery,and the control group was significantly smaller than the observation group(P<0.05).ROM of the upper and lower segments was increased after surgery,and the observation group was significantly smaller than the control group(P<0.05).There was no significant difference in ODI scores between the two groups before surgery(P>0.05).ODI scores were decreased after 6 months of surgery,and the scores of the observation group were significantly lower than those of the control group(P<0.05).Conclusion Dynesys internal fixation through Wiltse approach has advantages of small trauma and quick postoperative recovery.Compared with traditional posterior inter-body fusion,it can retain the ROM of the surgical segment,reduce the pain and over-activity of adjacent segments.It has unique advantages in the treatment of single-segment lumbar disc herniation.Therefore,it is worthy of clinical promotion.