Dynesys系统不同应用方式治疗椎间盘退变性疾病的临床疗效

目的总结动态中和系统（ dynamic neutralization system，Dynesys ）作为融合或非融合器械治疗椎间盘退变性疾病（ degenerative disc disease，DDD ）的临床效果。方法2010年2月至2012年8月应用 Dynesys 治疗 DDD 患者51例，其中男22例，女29例，年龄38～74岁，平均54.6岁。本组病例单节段34例，双节段15例，三节段2例，使用方法包括非融合、融合和混合应用，其中单节段融合12例，非融合22例，双节段非融合5例，混合应用10例，三节段1例非融合，1例混合应用。共固定70个节段，其中融合23个节段，非融合47个节段。手术方法：融合节段行椎板开窗减压、侧隐窝开放、间盘切除、PLIF （自体骨或混合骨粒），非融合节段仅行椎板开窗减压、侧隐窝开放、间盘有限切除。通过 Oswestry 功能障碍指数（ oswestry disability index，ODI ）和疼痛视觉模拟量表（ visual analogue scale，VAS ）评估临床疗效，并通过侧位 X 线片和 CT 二维重建评估融合节段的椎间融合率，动态侧位 X 线片评估非融合节段的运动功能保留情况。结果随访时间6～28个月，平均23个月。VAS 腰痛评分术前5.9±1.7，术后2.0±1.5（ P＜0.05）。下肢痛评分术前7.3±1.6，术后1.6±1.5（ P＜0.05）。ODI 指数术前（61±19）%，术后（22±13）%（ P＜0.05）。47个非融合固定节段中有31个（66%）节段保留有椎间活动度，活动范围2°～6°，平均3.5°，但椎间活动度较术前明显减小（ P＜0.05）。23个融合节段均无椎间活动度，融合率56.5%。无不可逆性神经症状加重、内植物失败、切口感染等并发症，临床疗效满意。结论Dynesys 治疗 DDD 的近期疗效满意，可在融合、非融合、混合应用不同方式中个体化选择。作为非融合器械使用仅能够部分保留椎间活动度。作为融合器械使用，能够提供椎间足够稳定，但植骨融合率低于坚强固定。

Clinical results of the Dynesys system in different treatment modes for degenerative disc diseases

Objective To investigate the indications of the dynamic neutralization system （ Dynesys ） in the treatment of lumbar degenerative disc diseases （ DDD ） as the fusion or non-fusion instrumentation, and to preliminarily evaluate the clinical results and imaging findings. Methods From February 2010 to August 2012, 51 patients with DDD were treated by the Dynesys system, including 22 males and 29 females, whose average age was 54.6 years old （ range; 38-74 years ）. The instrumentations were used in 34 single-level cases, 15 double-level cases and 2 three-level cases. The options were fusion, non-fusion, and hybrid use of fusion and non-fusion. Single-level fusion was performed in 34 cases, non-fusion in 22 cases, double-level non-fusion in 5 cases, hybrid use in 10 cases, three-level non-fusion in I case and hybrid use in 1 case. A total of 70 segments were performed with fixation, with fusion in 23 segments and non-fusion in 47 segments. The fusion segments were performed posterior decompression, lateral recess opening, disc resection and posterior lumbar interbody fusion （ PLIF ） （ autologous bone or mixed bone particles ）, whereas the non-fusion segments were performed only posterior decompression and lateral recess opening, with or without disc resection. The oswestry disability index （ ODI ） and visual analogue scale （ VAS ） scores were used to assess the clinical results. The fusion rates of fusion segments were evaluated by lateral X-ray films and CT two-dimensional reconstruction, and the maintenance of the range of motion （ ROM ） of non-fusion segments were evaluated by dynamic lateral X-ray films. Results The mean follow-up time was 23 months （ range; 6-28 months ）. The preoperative VAS score of back pain was 5.9±1.7, and the postoperative score was 2.0±1.5 （ P〈0.05 ）. The preoperative VAS score of leg pain was 7.3±1.6, and the postoperative score was 1.6±1.5 （ P〈0.05 ）. The preoperative ODI was （ 61~19 ） %, and the postoperative ODI was （ 22±13 ） % （ P〈0.05 ）. In the 47 non-fusion segments, the intervertebral motion was reserved to a certain extent in 31 segments （ 66% ）. The average ROM was 3.5° （ range; 2%-6% ）, whereas it was significantly decreased when compared with that preoperatively （ P〈0.05 ）. None of the 23 fusion segments had intervertebral motion, with a fusion rate of 56.5%. No complications such as irreversible neurologic symptoms, implant failures, incision infections were found, with satisfactory clinical results. Conclusions The preliminary clinical results of the Dynesys system in the treatment of DDD are satisfactory. It can be determined in fusion, non-fusion, or hybrid use according to the individual needs. Used as the non-fusion instrumentation, it can only reserve part of the intervertebral motion. Nevertheless, when used as the fusion instrumentation, it can keep the intervertebral stability, but the fusion rate was lower than that of the solid instrumentation.