Dynesys系统结合PLIF在多节段腰椎退行性疾病的应用

目的:探讨Dynesys动态稳定系统联合腰椎后路椎间融合(PLIF)在腰椎多节段退变性疾病治疗中的临床疗效。方法:对2010年9月至2013年5月采用Dynesys动态稳定系统结合PLIF治疗的46例多节段腰椎退变性疾病患者进行回顾性分析,男17例,女29例;年龄38～68岁,平均(56.38±11.63)岁。手术节段:L₂-L₅ 16例(6例融合L_4,5,10例融合L_3,4、L_4,5);L₃-S₁ 30例(11例融合L₅S₁,19例融合L_4,5、L₅S₁).术后分别指术后3个月、术后1年和末次随访。分析内容包括:Oswestry功能障碍指数(ODI)、腰痛和腿痛的视觉模拟评分(VAS),并通过腰椎动力位X线观察节段活动度(ROM)、椎间隙高度(DHI)的变化情况。结果:术后随访时间16～48个月,平均(23.23±7.34)个月,术后3次随访腰痛、腿痛VAS 及ODI均较术前有明显降低 (p<0.01);融合节段椎间隙高度较术前明显增大(p<0.05),邻近非融合节段椎间隙高度与术前比较无明显变化(p>0.05);融合手术节段术后活动度均较术前显着减小(p<0.01),非融合的手术节段活动度均较术前减少(p<0.05).上邻近非融合手术节段活动度术前与术后3个月及术后1年比较差异无统计学意义(p>0.05),但与末次随访时比较时活动度增加(p<0.05).结论:Dynesys动态稳定系统结合PILF治疗腰椎多节段退行性疾病的近期疗效满意,可在融合、非融合中个体化选择。能够部分保留椎间活动度,预防邻近节段早期退变的发生,但长期临床疗效还需长时间临床观察。

Application of Dynesys system combined with posterior lumbar interbody fusion in treating multiple lumbar degenerative disease

Objective:To explore the clinical effects of Dynesys system combined with posterior lumbar interbody fusion (PLIF) in treating multiple lumbar degenerative disease. Methods:The clinical data of 46 patients with multiple lumbar degenerative diseases treated by Dynesys system combined with PLIF from September 2010 to May 2013 were retrospectively analyzed. There were 17 males and 29 females,aged from 38 to 68 years old with an average of (56.38±11.63) years. Operation section was in L₂-L₅ of 16 patients (6 with fusion of L_4,5 and 10 with fusion of L_4,5,L₅S₁) and in L₃-S₁ of 30 patients (11 with fusion of L₅S₁ and 19 with fusion of L_4,5,L₅S₁). Patients were followed up for three times:postoperative 3 months,l year and final follow-up. Visual analogue scale(VAS) and Oswestry Disability Index(ODI) were used to assess clinical symptoms preoperatively and postoperatively. All patients underwent flexion/extension radiographs examinations before surgery and at final follow-up. Range of motion(ROM) and disc height index(DHI) were recorded. Results:All patients were followed up from 16 to 48 months with the mean of (23.23±7.34) months. At third follow-up after operation,ODI and VAS of lumbago and leg pain were significant improved than that of preoperative (p<0.01). DHI of fusion segment was significantly increased than that of preoperative(p<0.05). There was no significant difference in adjacent non-fusion segment between preoperative and postoperative(p>0.05). Postoperative ROM of fusion and non-fusion segments were obviously decreased than that of preoperative. There was no significant difference in ROM of upper adjacent non-fusion segment between 3 months and 1 year after operation(p>0.05),but at final follow-up,the ROM was increased(p<0.05). Conclusion:The preliminary clinical results of the Dynesys system combined with PLIF in the treatment of multiple lumbar degenerative diseases are satisfactory. It can be determined in fusion or non-fusion according to the individual needs and can reserve the some intervertebral motion,prevent the early degeneration of adjacent segments. However,its long-term clinical efficacy should be verified with long time.