Dynesys动态固定系统对腰椎间盘突出症的2年期疗效分析

Analysis of 2-year efficacy of the dynamic neutralization using the Dynesys system on lumbar disc herniation

目的探讨Dynesys内固定系统治疗腰椎间盘突出症(LDH)的安全性和短期疗效。方法选择LDH患者68例分为TLIF对照组(39例)和Dynesys试验组(29例)。比较2组手术前后疼痛视觉模拟评分(VAS)、功能障碍指数(ODI)评估临床治疗效果。测量手术前后2组手术节段和头侧相邻节段的椎间活动度(Range of motion,ROM),评估椎体间的稳定性。比较手术前后2组头侧相邻节段椎间小关节间隙距离及椎间盘髓核退变表现(Woodend分级),评估头侧临近节段退变情况。测量试验组手术节段椎间盘表观扩散系数(apparent diffusion coefficient,ADC),评估试验组固定节段椎间盘退变程度。结果随访时间(26.3±2.1)个月。2种方法术后末次随访,ODI和VAS评分均较术前有显著改善,但2组间差异无统计学意义(P>0.05)。试验组在固定节段仍保持活动度并能够限制相邻节段屈伸活动,2组间比较差异性有统计学意义(P<0.05)。比较手术前后试验组ADC值,差异无统计学意义(P>0.05)。末次随访,对照组头侧相邻节段椎间小关节间隙距离及该节段髓核信号较术前差异有统计学意义(P<0.05)。组间比较差异有统计学意义(P<0.05)。结论Dynesys固定系统在保留了手术节段椎体间活动度的同时,延迟头侧相邻节段的退化。其治疗椎间盘突出症的短期疗效令人满意。

Objective To explore the safety and short-term efficacy of the dynamic neutralization using the Dynesys internal fixation system on lumbar disc herniation(LDH).Methods A total of 68 LDH patients were assigned into transforaminal lumbar interbody fusion(TLIF)(the control group,n=39)and Dynesys experimental group(n=29).Before and after operation,the scores of Visual Analogue Scale(VAS)and Oswstry Dysfunction Index(ODI)were perform to evaluate the clinical therapeutic effect between groups.The intervertebral range of motion(ROM)of the operative segment and the cephalad adjacent segments before and after surgery was measured to evaluate the stability of the intervertebral body.The distance of intervertebral facet joint space and disc nucleus pulposus degeneration(Woodend classification)before and after surgery were measured to evaluate the degeneration of adjacent segments on the cephalic side.The apparent diffusion coefficient(ADC)of the operative segmental intervertebral disc in the experimental group was measured to evaluate the degeneration degree of the fixed segmental intervertebral disc.Results The mean follow-up period was(26.3±2.1)months.In both groups,ODI and VAS scores at the last follow-up visit after surgery were improved compared with preoperative ones,although significant differences were not detected(P>0.05).Patients in the experimental group still maintained mobility in a fixed segment and they were able to restrict the flexion extension activity of adjacent segments,with significantly different between groups(P<0.05).There were no significant differences between preoperative and postoperative ADC values(P>0.05).At the last follow-up,there were significant differences in the distance between facet joint space in cephalad adjacent segment and the signal of nucleus pulposus in this segment compared with preoperative levels,which were also significantly different between groups(P<0.05).Conclusion The Dynesys internal fixation system not only maintains the range of motion of operative segmental intervertebral disc,but also delays the degeneration of adjacent segments on the cephalic side,showing an acceptable short-term efficacy on LDH.