Dynesys动态固定治疗腰椎退行性疾病的并发症及其预防策略

The complications and prevention strategies of Dynesys dynamic stabilization for lumbar degenerative disease

目的探讨Dynesys动态固定治疗腰椎退行性疾病的并发症及其预防策略。方法回顾性分析2008年7月至2016年12月采用Dynesys动态固定治疗腰椎退行性疾病患者243例,随访时间平均5.6年(范围48~148个月)。腰椎间盘突出症152例,腰椎管狭窄症91例。单节段167例,双节段71例,三节段5例。所有患者均有腰痛、下肢放射痛和(或)间歇性跛行。采用Oswestry功能障碍指数(Oswestry disability index,ODI)和疼痛视觉模拟评分(visual analogue scale,VAS)评估临床疗效。分析患者围手术期并发症(3个月以内)和术后并发症(3个月以后)发生情况。采用加州大学洛杉矶分校评分系统(University of California at Los Angeles Grading Scale,UCLA)评价影像学邻近节段退变(adjacent segment degeneration,ASD)情况。结果所有患者均顺利完成手术。ODI由术前55.1%±16.8%改善至末次随访时15.6%±5.8%,差异有统计学意义(t=34.6,P<0.01)。VAS评分由术前(6.4±2.3)分降至末次随访时(1.1±0.4)分,差异有统计学意义(t=35.4,P<0.01)。术后共25例(10.29%)患者发生并发症,3例(1.23%)患者接受再次手术。围手术期并发症13例(5.35%),包括脑脊液漏和切口愈合不良各5例(2.06%),切口深部感染3例(1.23%);术后并发症12例(4.94%),包括6例(2.47%)螺钉松动、3例(1.23%)螺钉断裂、3例(1.23%)症状性ASD(2例行再次手术治疗、1例行保守治疗)。所有患者均无手术节段复发。末次随访时41例(16.87%)患者出现影像学ASD,UCLA评分术前和末次随访的差异有统计学意义(Z=2.60,P=0.01)。结论Dynesys动态固定结合减压治疗腰椎退行性疾病可获得良好的长期临床疗效,具有较低的并发症和ASD发生率。

Objective To investigate the complications and prevention strategies of Dynesys stabilization in the treatment of lumbar degenerative disease.Methods Two hundred and forty-three patients underwent lumbar spine stabilization with Dynesys owing to lumbar degenerative disease were retrospectively analyzed from July 2008 to December 2016.The mean follow-up time was 5.6 years(48-148 months).There were 152 patients with lumbar disc herniation and 91 patients with lumbar spinal stenosis.167 cases underwent single-level operation,71 cases underwent two-level operation,and 5 cases underwent three-level operation.All patients had low back pain,radiating pain in the lower extremities,and/or intermittent claudication.Clinical outcomes were evaluated using Oswestry disability index(ODI)and visual analogue scale(VAS).The occurrence of perioperative complications(with in 3 months)and postoperative complications(after 3 months)after the operation were recorded and analyzed.Radiographic adjacent segment degeneration(ASD)was evaluate dusing University of California at Los Angeles Grading Scale(UCLA).Results All patients underwent surgery successfully.ODI score of patients improved from 55.1%±16.8%preoperatively to 15.6%±5.8%at the final follow-up,the difference was statistically significant(t=34.6,P<0.01).VAS score decreased from 6.4±2.3 preoperatively to 1.1±0.4 at the final follow-up,the difference was also statistically significant(t=35.4,P<0.01).There were 25 cases(10.29%)with complications,and 3 cases(1.23%)underwent secondary operation.Perioperative complications occurred in 13 patients(5.35%),including 5 cases of cerebros pinal fluid leakage,5 cases of poor wound healing(2.06%),and 3 cases of deep wound infection(1.23%).Twelve patients(4.94%)had long-term postoperative complications,including 6 patients(2.47%)of unilateral screw loosening at the 5-year follow-up,3 patients(1.23%)of screw fracture,and 3 patients(1.23%)of symptomatic ASD,among whom 2 patients underwent secondary operation,and 1 patient underwent conservative treatment.There was no recurrence at the operated segments in all patients.At the final follow-up,41 patients(16.87%)had radiographic ASD.The UCLA score atthe final follow-up was significantly different from that preoperatively(Z=2.60,P=0.01).Conclusion Dynesys dynamic system combined with decompression in the treatment of degenerative lumbar spine diseases can achieve good long-term clinical outcome,with low incidence of complications and ASD.