对比Dynesys与椎间融合术治疗双节段腰椎退行性疾病的中长期疗效

Medium and long-term comparisons of Dynesys stabilization and posterior lumbar interbody fusion for two-level lumbar degenerative diseases

目的评估使用Dynesys动态稳定系统与后路腰椎椎体间融合术(posterior lumbar interbody fusion,PLIF)治疗双节段腰椎退行性疾病的中长期疗效。方法回顾性收集2010年6月至2012年6月收治的43例双节段腰椎退行性疾病患者资料,其中男26例,女17例;年龄(54.2±18.3)岁(范围40~78岁)。43例中采用Dynesys动态固定23例(Dynesys组),行PLIF者20例(PLIF组)。随访过程中采用腰椎正侧位、过伸过屈位X线片观察手术节段椎间隙高度、上端固定椎的相邻节段椎间隙高度及两者的活动度(range of motion,ROM),并应用加州大学洛杉矶分校(University of California at Los Angeles,UCLA)系统评价邻近节段退行性变情况;采用Oswestry功能障碍指数(Oswestry dability index,ODI),疼痛视觉模拟评分(visual analogue score,VAS)评估临床疗效。结果43例随访时间(105.3±8.7)个月(范围60~120个月)。Dynesys组术前及末次随访时的手术节段椎间隙高度以及上端固定椎的相邻节段椎间隙高度与PLIF组的差异无统计学意义。PLIF组术后手术节段活动度显著降低,上端邻椎活动度明显增加,与Dynesys组的差异有统计学意义(t=4.261,P<0.05;t=4.834,P<0.05)。根据UCLA系统评分标准,Dynesys组3例出现上端邻近节段影像学退变,PLIF组11例,差异有统计学意义(P<0.05)。Dynesys组与PLIF组的VAS评分和ODI指数在末次随访时均较术前显著降低,但组间差异无统计学意义。在二次手术方面,Dynesys组仅1例出现症状学邻近节段退变,二期行微创椎间孔镜手术治疗,而后者则出现3例再次行手术治疗(行经椎间孔入路椎间植骨融合者1例,行PLIF者2例)。结论Dynesys动态稳定内固定系统与PLIF腰椎融合术在治疗双节段腰椎退行性疾病时均可以取得较为满意的临床疗效,但前者在维持腰椎一定的活动度及预防邻近节段进一步退变方面更有优势。

Objective To evaluate the clinical efficacy and changes between Dynesys and Posterior lumbar interbody fusion(PLIF)in the treatment of two-level lumbar degenerative disease.Methods 43 consecutive patients with lumbar degenerative disease were treated using the Dynesys or PLIF between June 2010 and June 2012.In all patients,23patients were implanted Dynesys and other patients for PLIF.The follow-up period was at least 60 months.Used the Visual analogue scale(VAS)and Oswestry disability index(ODI)to evaluate the clinical outcomes.And during the follow-up period,collected the data for the intervertebral height and the range of motion(ROM),for the operation section and the upper adjacent vertebral.MRI and Grading Scale from the University of California at Los Angeles(UCLA)were used to define the change of intervertebral disc signal.Results The ODI index and VAS score both improved significantly at the final follow-up evaluation(P<0.05),as compared to the basal line values.And in terms of imaging,there were no significant difference in the vertebral height of the operation section and the upper adjacent vertebral.The range of motion(ROM)for the operative section in the group of PLIF was significantly lower than that in Dynesys group(P<0.05).And when it comes to the upper adjacent vertebral space,it was higher at the same time(P<0.05).According to the UCLA Grading Scale,there were 3 cases in the Dynesys group and 11 in the PLIF group had radiological adjacent degeneration,the difference was significant between two groups(P<0.05).And when it comes to the second intension,there were 3 patients in PLIF groups(TLIF 1;PLIF 2)but only 1 in Dynesys groups.Conclusion Dynesys and PLIF are both effective for lumbar degenerative disease and show good medium and long-term clinical and radiographic results.But when it comes the risks in developing ASD and the ROM of adjacent segments,Dynesys stabilization can be the better choice.