摘要
目的探讨Dynesys动态稳定系统在腰椎退变性疾病治疗中的临床疗效。方法回顾分析2008年7月～2012年5月采用Dynesys动态固定系统治疗的腰椎椎管狭窄症和椎间盘突出症患者120例,随访>2年的共52例,其中腰椎椎管狭窄症40例,椎间盘突出症12例。术前腰椎疼痛视觉模拟量表(visual analogue scale,VAS)评分为5.5分(3.0～9.0分),腿痛VAS评分5.36分(2.6～9.0分),Oswestry功能障碍指数(Oswestry disability index,ODI)为61.4%。测量术后末次随访时患者腰痛、腿痛的VAS评分及ODI。测量手术前后手术节段椎间盘的高度,置入节段的活动度,固定节段头侧邻近节段的椎间活动度。结果 52例患者平均随访29个月。手术时间95 min±16 min,术中出血量183 mL±32 mL。脑脊液漏1例,经改变体位及换药局部处理后愈合;1例切口脂肪液化,经换药对症处理后愈合。围手术期无死亡病例,术后症状无加重,神经功能无恶化。患者腰痛VAS评分在末次随访时较术前有明显的降低,腿痛VAS评分也较术前有明显的降低,ODI较术前也有明显的降低。手术后椎间隙高度有所降低,但与术前相比差异无统计学意义(P>0.05);固定节段椎间活动度明显减小,与术前相比差异有统计学意义(P<0.05);手术固定节段头侧邻近节段活动度有所增加,但与术前相比差异无统计学意义(P>0.05)。结论 Dynesys动态固定系统手术操作简单、易掌握,可避免融合术相关并发症,效果满意。Dynesys系统固定上端的邻近节段活动度较术前略有增加(P>0.05),其长期临床疗效以及能否减少术后相邻节段退变的发生率等还需长时间、大宗病例的临床观察。
Objective To explore the clinical efficacy of Dynesys system for treatment of lumbar degenerative disc disease.Methods The clinical data（from July 2008 to May 2012） of 120 patients with lumbar degenerative disc disease,who were treated with Dynesys system,were retrospectively reviewed.A total of 108 cases were followed;and 52 cases were followed-up for more than 2 years,including 24 males and 28 females.There were 40 cases having lumbar canal stenosis and 12 having lumbar disc herniation.The mean preoperative visual analogue scales（VAS） score was 5.5（3-9） for the low back pain and 5.36（2.6-9.0） for the leg pain,with the Oswestry disability index（ODI） being 61.4%.The height and range of motion（ROM） of fixed disc were measured preoperatively and postoperatively.The ROM of proximal adjacent segment was measured at the same time.Results The mean follow-up period was 29 months in the 52 cases.The operation time was 95 min±16 min,with blood loss of 183 mL±32 mL.There were no death patient,no aggravation of symptom,or deterioration of neurological function.One case developed cerebrospinal fluid leakage and was cured with changing position and local dressing;one case with wound fat liquefaction was cured with debridement and dressing.The postoperative VAS score of the low back pain was significantly reduced（P0.05） compared with the preoperative one.The same reduction was also noticed in leg pain VAS score and ODI（P0.05）.The intervertebral height was decreased after operation,but without significant difference（P0.05）.The ROM of fixed segment was significantly reduced（P0.05）.The ROM of the proximal adjacent segment was increased,but without significant difference（P0.05）.Conclusion Dynamic fixation system Dynesys is simple and easy to master,and it can avoid fusion surgery-related complications.The clinical result is satisfactory.Certain ROM does exist in fixed segment.The ROM of proximal adjacent segment increase slightly.However,its long-term clinical efficacy and the ability
出处
《脊柱外科杂志》
2012年第5期288-292,共5页
Journal of Spinal Surgery
关键词
腰椎
椎管狭窄
椎间盘移位
内固定器
Lumbar vertebrae
Spinal stenosis
Intervertebral disk displacement
Internal fixators
