L3~5节段退变性疾病融合与非融合术式的选择

目的：比较采用动态中和固定系统( Dynesys)及腰椎后路椎间融合术( PLIF)治疗L3~5节段退变疾病的短期临床疗效。方法回顾性分析采用 Dynesys 及 PLIF 手术治疗L3~5节段退变疾病患者46例,比较两组手术时间、术中出血量、术后住院时间,术前、术后3个月及末次随访时腰腿疼痛视觉模拟( VAS)评分、Oswestry 功能障碍指数( ODI)、手术节段及临近节段活动度( ROM)变化。结果46例患者均获随访,Dynesys组平均随访时间(20±7)个月,手术时间(168±19)min,出血量(481±169)ml,术后住院时间(9±2)d,PLIF组平均随访时间(16±6)个月,手术时间(204±20) min,出血量(635±168) ml,术后住院时间(8±2) d；两组患者腰腿痛VAS评分、ODI评分在术后3个月及末次随访时较术前有明显的改善(P<0．05),两组间术前、术后3个月及末次随访时评分差异均无统计学意义。 Dynesys组手术节段术后ROM较术前减低(P<0．05),PLIF组手术节段ROM在术后消失,两组临近节段ROM在术前、术后3个月及末次随访时无明显改变；两组间手术节段ROM在术后3个月及末次随访时差异有统计学意义( P<0．05),临近节段ROM差异无统计学意义。结论在治疗L3~5节段退变疾病时Dynesys和PLIF手术均可取得良好的手术治疗效果,但Dynesys具有较短的手术时间及更少的术中出血量,可保留手术节段一定的活动度,因此在具有相同手术适应症的L3~5节段腰椎退变性患者建议行Dynesys手术治疗。

The choose of fusion or non-fusion surgery in treatment of L3~5 segments lumbar degenerative disease

Objective To compare the short-term clinical efficacy of dynamic neutralization system( Dynesys) and posterior lumbar interbody fusion( PLIF) in treatment of L3~5 lumbar degenerative disease. Methods 46 patients with L3~5 lumbar degenerative disease were treated by Dynesys and PLIF to compare the difference in surgical time, blood loss volume, post-op hospital stay in two groups. All patients underwent visual analogue scale( VAS) scores, oswestry disability index( ODI) , operative and adjacent segments range of motion( ROM) in pre-op, 3 months post-op and final follow-up. Results All patients got the follow-up. In Dynesys group, mean follow-up time was (20 ± 7)months, mean surgical time was (168 ± 19)minutes, mean blood loss was (481 ± 169) ml, mean post-op hospi-tal stay was (9 ± 2)days. In PLIF group, mean follow-up time was (16 ± 6)months, mean surgical time was (204 ± 20)minutes, mean blood loss was (635 ± 168)ml, mean post-op hospital stay was (8 ± 2)days. All patients got significant improvement in VAS scores, ODI scores after the operation ( P<0. 05 ) . There was no obvious differ-ence between two groups. In Dynesys group, operative segments ROM got decrease ( P <0. 05 ) , and in PLIF group, operative segments ROM disappeared after the operation. Adjacent segments ROM had no significant chan-ges after the operation in both groups. The difference of operative segments ROM had statistical significance be-tween two groups (P<0. 05), but no in adjacent segments. Conclusion Both Dynesys and PLIF get the satisfac-tory clinical outcome in treatment of L3~5 lumbar degenerative disease, but Dynesys has shorter surgical time and less blood loss than PLIF. It contains ROM in operative segments, so it is better to select Dynesys to treat L3~5 seg-ments lumbar degenerative disease with the same operation indications.