Dynesys治疗腰椎退变性疾病内固定并发症的临床研究

A clinical research on internal fixation complications of Dynesys in the treatment of lumbar degenerative diseases

目的研究分析Dynesys(Dynamic Neutralization System:动态稳定系统)治疗腰椎退变性疾病的内固定并发症发生情况,及其危险因素和预防措施。方法对2013年3月~2020年12月接受腰椎后路Dynesys内固定的135例腰椎退变性疾病患者进行回顾性分析。术前、术后1周、术后3个月、术后半年及末次随访均拍摄腰椎正侧位片及腰椎CT。术前评估椎弓根和椎管形态,术后评估螺钉位置及有无松动、断裂,评估间隔器位置及绳缆的连续性。分析发生内固定并发症病例的临床和影像学特点,并总结危险因素及对策。结果术后随访6个月~8年,平均(3.6±2)年。内固定相关并发症情况:(1)椎弓根螺钉偏内2例,无临床症状,予随访观察;(2)螺钉松动6例,其中单节段1例、双节段3例、三节段2例,6例体质量指数均偏高,无明显临床症状,均无需翻修;(3)迟发感染1例,为2型糖尿病患者,行内固定取出术后痊愈。无断钉,无间隔器、绳缆异常。结论Dynesys治疗腰椎退变性疾病的内固定并发症较少,以内固定松动最常见。固定到S 1、合并体质量指数偏高、多节段固定、上端椎为腰椎前凸顶点、2型糖尿病可能是内固定并发症的危险因素。

Objective To study the risk factors and preventive measures of internal fixation complications in the treatment of lumbar degenerative diseases with Dynesys.Methods A retrospective study was conducted on the clinical data of 135 patients who were treated by posterior Dynesys internal fixation for lumbar degenerative diseases from March 2013 to December 2020.Anteroposterial-lateral lumbar radiographs and lumbar CT were taken at pre-operation,postoperative 1 week,postoperative 3 months,postoperative 6 months and the last follow-up.Pedicle and spinal canal morphology were evaluated pre-operation.Postoperatively,the screw position and whether it was loose or broken,pacer position and cable continuity were evaluated.The clinical and imaging characteristics of internal fixation complications were analyzed,and the risk factors and countermeasures were summarized.Results The patients were followed up for 6 months to 8 years,average(3.6±2)years.Complications related to internal fixation:(1)There were 2 cases of pedicle screw deviation,with no clinical symptoms,follow-up observation was carried out.(2)There were 6 cases of screw loosening,including 1 case of single segment,3 cases of double segment,2 cases of triple segment,and 6 cases of high body mass index(BMI),all of them had no obvious clinical symptoms and did not need revision.(3)1 case of delayed infection was found,and the patient had type 2 diabetes who was cured after removal of internal fixation.No pedicle screw fracture,no spacer or cable abnormality was observed.Conclusion Dynesys has less internal fixation complications in the treatment of lumbar degenerative diseases,internal fixation loosening is the most common.Fixation to S1,high BMI,multilevel fixation,the upper vertebral body is the lumbar lordosis apex and with type 2 diabetes may be risk factors for internal fixation complications.