动态中和系统Dynesys在腰椎间盘突出症患者中的应用及疗效观察

目的观察后路Dynesys动态中和系统在腰椎间盘突出症的近期疗效及安全性。方法 2010年4月-2012年4月,对经症状及动力位X线、CT、MRI等确诊的30例腰椎间盘突出症患者行Dynesys动态中和系统螺钉固定结合全椎板切除减压手术,术后随访6～12个月,分别于术前1 d、术后1周、术后3个月、术后6个月患者行视觉模拟评分（VAS）及Oswestry功能障碍指数（ODI）评分并进行配对t检验。结果术前1 d VAS评分为（7.9±0.9）分,术后1周、3个月、6个月VAS评分分别为（2.1±0.8）、（1.6±0.4）、（1.4±0.3）分,与术前1 d相比差异均有统计学意义（P〈0.001）。术前1 d ODI为（74.0±6.0）%,术后1周、3个月、6个月ODI分别为（19.6±2.5）%、（16.3±1.2）%、（14.5±1.8）%,与术前1 d相比差异均有统计学意义（P〈0.001）。术后1周、3个月、6个月均给予X线复查,未发现螺钉松动及断钉。结论 Dynesys后路动态中和系统与减压结合在腰椎间盘突出症近期疗效安全确切,Dynesys保留了病变腰椎的活动度,保证了后柱稳定性,纠正腰椎失稳。

Observation of the Clinical Effect of Dynesys System on Patients with Lumbar Disc Prolapse

Objective To observe the efficacy and safety of the posterior fusion dynamic system（Dynesys） on lumbar intervertebral disc. Methods Between April 2010 and April 2012, 30 patients diagnosed lumbar disc herniation in our department were included in the study. The Dynesys was performed on these patients. Followup lasted for 6 to 12 months. We used visual analogue scale（VAS） and Oswestry disability index（ODI） to evaluate the efficacy and safety of the system at the time points of the day before surgery, 1 week, 3 months and 6 months after surgery. Paired-samples t-test was used in the data analysis. Results The VAS score 1 day before surgery was 7.9 ± 0.9; 1 week after surgery, VAS was 2.1 ± 0.8（t=49.395, P0.001）; 3 months after surgery, VAS was 1.6 ± 0.4（t=88.304, P〈0.001）; 6 months after surgery, VAS was 1.4 ± 0.3（t=93.721, P〈0.001）. ODI 1 day before surgery was（74.0 ± 6.0）%; 1 week after surgery, ODI was（19.6 ± 2.5）%（t=82.006, P〈0.001）; 3 months after surgery, ODI was（16.3 ± 1.2）%（t=88.344, P〈0.001）; 6 months after surgery, ODI was（14.5 ± 1.8）%（t=90.113, P〈0.001）. All the patients were given X ray review 1 week, 3 months, and 6 months after surgery. No screw loosening or breakage was detected. Conclusions The combination of Dynesys and decompression surgery has been proved to be effective and safe in the short term. Dynesys reserves the mobility of pathological lumbar, ensures the stability of the posterior spine and corrects lumbar instability.