摘要
目的探讨单节段腰椎间盘突出症患者应用椎弓根螺钉Dynesys系统、棘突间Wallis系统治疗的有效性及安全性。方法 60例腰椎间盘突出症患者随机分为2组,Dynesys组30例采用椎弓根螺钉Dynesys系统治疗,Wallis组30例采用棘突间Wallis系统治疗。记录2组手术时间、术中出血量、住院时间。随访8年,记录术前及术后1、3、12个月腰、腿痛视觉模拟评分(visual analogue scale, VAS);比较术前及术后1、3、5、8年日本骨科协会(Japanese Orthopaedic Association, JOA)评分及Oswestry功能障碍指数(Oswestry Disability Index, ODI);比较术前及术后4、8年手术节段及邻近节段椎间活动度(range of motion, ROM)、椎间隙高度;统计随访期间腰椎间盘突出症复发、棘突骨折以及内固定失败等并发症发生情况。结果 Dynesys组手术时间、住院时间较Wallis组长,术中出血量较Wallis组多(P<0.05)。2组术后1、3、12个月腰痛、腿痛VAS评分均较术前降低(P<0.05),2组间比较差异均无统计学意义(P>0.05)。2组术后1、3、5、8年ODI均较术前降低,JOA评分较术前增高(P<0.05);2组术后4、8年手术节段ROM均较术前降低(P<0.05),椎间隙高度与术前比较差异无统计学意义(P>0.05);术后4、8年邻近节段椎间隙高度、ROM与术前比较差异无统计学意义(P>0.05);以上数据2组间比较差异均无统计学意义(P>0.05)。Dynesys组1例术后8年邻近节段发生退变,无任何临床症状;Wallis组1例术后6年腰椎间盘突出症复发,行后路融合内固定术后症状缓解,末次随访时未见复发。结论 Dynesys与Wallis系统治疗单节段腰椎间盘突出症均可维持手术节段椎间隙高度,保留手术节段一定的活动度,对邻近节段影响较小。
Objective To investigate the effect and safeties of Wallis and Dynesys dynamic stabilization systems for single-segment lumbar disc herniation. Methods Sixty patients with lumbar disc herniation were randomly divided into 30 patients receiving Dynesys dynamic stabilization system(Dynesys group) and 30 patients receiving Wallis dynamic stabilization system(Wallis group). The operation lasting time, intraoperative blood loss and length of hospitalization stay were recorded in two groups. All patients were compared the visual analogue scale(VAS) score of lumbar and leg pain before as well as 1, 3 and 12 months after operation, the Japanese Orthopaedic Association(JOA) score and Oswestry Disability Index(ODI) before as well as 1, 3, 5 and 8 years after operation, and the range of motion(ROM) of surgical segment and adjacent segments and the intervertebral height before as well as 4 and 8 years after operation. The recurrence of intervertebral disc herniation,fracture of spinous process,failure of internal fixation and other complications were recorded.Results The operation lasting time and the length of hospitalization stay were longer,and the intraoperative blood loss was more in Dynesys group than those in Wallis group(P<0.05).Compared with before operation,the VAS scores of lumbar and leg pain were lower,ODI decreased,JOA increased,and ROM of surgical segment decreased(P <0.05),while intervertebral height of surgical segment,ROM of adjacent segment and intervertebral height of adjacent segment showed no significant differences(P>0.05).All above indexes showed no significant differences between two groups(P>0.05).Dynesys group had adjacent segment degeneration in 1 patient 8 years later with no clinical symptom;Wallis group had recurrence of lumbar disc herniation in 1 patient 6 years later,which disappeared after posterior decompression and fusion internal fixation.Conclusion Both Dynesys and Wallis dynamic stabilization systems can maintain the intervertebral height of the surgical segment,retain a certain degree
作者
李宗阳
简磊
来佳辉
万顺
杨彬
王小刚
王亚寒
罗建平
LI Zongyang;JIAN Lei;LAI Jiahui;WAN Shun;YANG Bin;WANG Xiaogang;WANG Yahan;LUO Jianping(Department of Spinal and Spinal Cord Surgery,Henan University People's Hospital,Henan Provincial People's Hospital,Zhengzhou450003,China;Department of Spinal and Spinal Cord Surgery,Zhengzhou University People's Hospital,Henan Provincial People's Hospital,Zhengzhou450003,China)
出处
《中华实用诊断与治疗杂志》
2020年第3期268-273,共6页
Journal of Chinese Practical Diagnosis and Therapy
基金
河南省医学科技攻关计划省部共建项目(2018010024)。
关键词
腰椎间盘突出症
Dynesys系统
Wallis系统
非融合手术
邻近节段退变
lumbar disc herniation
Dynesys dynamic stabilization system
Wallis dynamic stabilization system
nonfusion
adjacent segment degeneration
