Dynesys动态稳定系统治疗下腰椎疾病效果观察

 目的 探讨Dynesys动态稳定系统治疗腰椎退行性疾病的应用指征及安全性。方法 回顾性分析2007 年1 月至2011 年12 月采用后路减压+Dynesys动态内固定系统治疗102例腰椎退行性疾病患者中69例完整的随访资料，男39例，女30例；年龄30~62岁，平均44岁；单纯腰椎间盘突出24例，腰椎间盘突出并退行性椎管狭窄35例，椎间盘退行性改变10例。手术固定节段: L_2，3 2例，L_3，4 4例，L_4，5 42例，L₅S₁15例，L₃~L₅ 5例，T₁₂~L₄ 1例。采用视觉模拟评分(visual analogue scale，VAS)评估疼痛；临床疗效评价采用Oswestry功能障碍指数(Oswestry disability index，ODI)。结果 手术时间为1.5~4.2 h，平均2.5 h；术中出血80~550 ml，平均320 ml。术后随访时间为6~44 个月，平均35个月。VAS评分，术前6~9分，平均8.6分；术后0~5分，平均2.8分。术前ODI为30%~91%，平均73%；术后为0~61%，平均30%。无一例发生钉绳系统和聚酯套管松动及深部感染。术后根据中华医学会骨科学分会脊柱学组腰背痛手术评定标准对手术疗效进行评价，优53 例，良12 例，可4 例，优良率为94.2%(65/69)。结论 Dynesys动态内固定系统能在保留腰椎手术节段活动度的同时保证术后临床症状恢复，是治疗腰椎退行性疾病的一种有效的非融合性、动力性固定方法。

Continuous clinical observation of the Dynesys dynamic neutralization system for degenerative lumbar spine diseases

Objective To evaluate the clinical indications and outcomes of dynesys neutralization system in the treatment of degenerative lumbar diseases. Methods From January 2007 to December 2011, 102 consecutive patients with degenerative lumbar spine diseases underwent posterior decompression and internal fixation with the Dynesys dynamic neutralization system. Among them, 69 patients were followed up, including 39 males and 30 females, aged from 30 to 62 years (average, 44 years). The series of cases were composed of 24 cases of lumber disc herniation, 35 cases of degenerative spinal stenosis, 10 cases of degenerative changes of lumbar discs. Results The mean follow-up period was 35 months (range, 6-44 months). The visual analogue scale (VAS) score decreased from preoperative 8.6 (range, 6-9) to postoperative 2.8 (range, 0-5), and the Oswestry disability index (ODI) improved from preoperative 73% (range, 30%-91%) to postoperative 30% (range, 0-61%). There were no implant failure or infection. According to the evaluation criteria of surgical treatment for low back pain, which was established by the Chinese Orthopaedic Association, the result was excellent in 53 patients, good in 12 patients, fair in 4 patients and poor in 1 patient. Conclusion The Dynesys dynamic neutralization system is effective in the treatment of degenerative lumbar spine disease, which can reserve the range of motion of stabilized segments, prevent degeneration of adjacent segments and improve clinical outcomes.