Dynesys动力内同定系统用于轻度腰椎退行性滑脱治疗的早期临床疗效分析

目的探讨动态中和固定系统（ dynamic neutralization system，Dynesys ）用于腰椎退行性滑脱治疗的早期临床疗效及相关影像学改变。方法2010年1月至2012年2月，我科对17例明确诊断为腰椎退行性滑脱的单节段病变患者进行了后路椎板开窗减压， Dynesys 系统内固定手术治疗。其中男6例，女11例；年龄53～72岁，平均61.3岁。手术节段分布：L3/4间隙3例，L4/5间隙10例，L5/S1间隙4例。使用疼痛视觉模拟评分（ VAS ）和功能障碍指数（ ODI ）进行疗效评估。通过术前及随访时 X 线片测量椎间隙高度比及椎间活动度。结果所有手术顺利完成，未发生严重的围手术期并发症。随访期间未发生内固定失败。术后随访12～22个月，平均15.4个月。VAS 腰痛评分：术前5.9±2.7，末次随访1.8±1.2；VAS 腿痛评分：术前3.1±2.4，末次随访1.2±0.9。ODI 指数：术前（39.4±17.3）%，末次随访（14.8±11.2）%。术前及随访时所有评分差异均有统计学意义（ P＜0.01）。椎体间高度比：术前2.5±1.2，随访时2.8±1.4，二者比较差异无统计学意义（ P＞0.05）。椎间活动度：术前（4.6±1.5）°，随访时（1.8±1.1）°，二者差异有统计学意义（ P＜0.05）。结论Dynesys 系统内固定是轻度腰椎退行性滑脱的一种早期疗效满意的治疗选择。

Early clinical effects of Dynesys dynamic internal fixation system for mild lumbar degenerative spondylolisthesis

Objective To investigate the early clinical effects and related radiological modifications of the Dynesys system, also called the dynamic neutralization system, for lumbar degenerative spondylolisthesis. Methods From January 2010 to February 2012, 17 patients who were definitely diagnosed as mono-level lumbar degenerative spondylolisthesis were treated with posterior laminectomy and Dynesys dynamic internal fixation system in our department. There were 6 males and 11 females, whose average age was 61.3 years old （ range; 53-72 years ）. The segmental distribution was stated as follows. There were 3 cases in L3/4, l0 Cases in L4/5 and 4 cases in L5/S1. The clinical effects were evaluated using the visual analogue scale （ VAS ） and oswestry disability index （ ODI ）. The height ratio of the intervertebral space and the range of intervertebral motion were measured based on X-rays preoperatively and in the follow-up. Results All the operations were performed successfully, and no severe per~operative complications occurred. During the follow-up, the failure of internal fixation was not found. The average follow-up time was 15.4 months （ range; 12-22 months ）. VAS scores of back pain： 5.9±2.7 preoperatively, 1.8±1.2 last follow-up; VAS scores of leg pain： 3.1±2.4 preoperatively and 1.2±0.9 last follow-up. ODI index： （ 39.4±17.3 ） % preoperatively and （ 14.8±11.2 ） % last follow-up. There were statistically significant differences in the ODI and VAS scores in the latest follow-up and preoperatively （ P〈0.01 ）. Height ratio： 2.5＋1.2 preoperatively and 2.8＋1.4 last follow-up. No statistically significant differences were found in the height ratio of the intervertebral space in the follow-up and preoperatively （ P〉0.05 ）. Range of intervertebral motion： （ 4.6±1 .5 ）% preoperatively and （ 1.8±1.1 ）° last follow-up. There were statistically significant differences between them （ P〈0.05 ）. Conclusions Dynesys dynamic internal fixation system is a therapy option for mild lumbar degenerative spondylolisthesis with satisfactory early clinical effects.