Dynesys治疗腰椎退变性疾病的临床疗效

目的回顾性分析 Dynesys 作为非融合器械治疗腰椎退变性疾病的临床疗效。方法2010年2月至2012年6月，应用 Dynesys 治疗腰椎退变性疾病患者42例，其中男24例，女18例；年龄38～74岁，平均54.6岁。全部病例均为退行性腰椎管狭窄、合并或不合并椎间盘突出。单节段32例，两节段10例。按标准操作置入 Dynesys 螺钉后行病变节段椎板间开窗减压，切除或保留椎间盘。清除增厚的黄韧带，切除增生内聚的上关节突的内侧部分，开放侧隐窝。测量椎弓根钉间距，截取 PCU 管，将 PET 绳索穿入 PCU 管和上下椎弓根钉间，收紧并锁定绳索与椎弓根钉连接处。术后5天戴腰围下地，腰围佩戴时间为3周。通过 ODI 和 VAS 评分评估临床疗效，并通过动态侧位 X 线片评估非融合节段的椎间运动功能保留及椎间隙高度和近端相邻节段活动度。结果随访10～36个月，平均24.7个月。ODI 指数术前（60.4±21.5）%，术后（23.9±13.5）%，（ P＜0.05）；VAS 腰痛评分术前6.0±1.8，术后2.1±1.7，（ P＜0.05）；VAS 腿痛术前评分7.2±1.9，术后1.9±1.1，（ P＜0.05），临床疗效满意。影像学评价非融合节段保留有一定椎间活动度，活动范围2°～5°，平均3.7°。结论Dynesys 动态固定治疗腰椎退变性疾病临床疗效满意，能够部分保留固定节段的运动功能，可作为退变性腰椎管狭窄及退变性椎间盘疾病的治疗选择。

Clinical results of the Dynesys system in the treatment of lumbar degenerative disease

Objective To retrospectively study the preliminary clinical results of the Dynesys system, as a non-fusion device, in the treatment of lumbar degenerative disease. Methods From February 2010 to June 2012, 42 patients with degenerative lumbar stenosis with or without disc protrusion were treated by the Dynesys system, including 32 cases of single segment and 10 cases of double segments. There were 24 males and 18 females, whose mean age was 54.6 years old （ range; 38-74 years ）. According to the standard operation, interlaminar decompression by fenestration was carried out in the segmental lesions after the Dynesys screw fixation, and the intervertebral discs were resected or retained. The pachynsis ligamentum flavum was removed, and the internal part of the hyperplasia cohesive superior articular process was resected, with the lateral recess open. The pedicle screw spacing was measured, and the polyhexymethylene carbonate polyurethane urea （ PCU ） tube was cut out. The polyethylene terephthalate （ PET ） robe was penetrated into the PCU tube between the upper and lower pedicle screws, and then the junctions between the rope and pedicle screws were tightened up and locked in. The patients could leave the sickbed with the waistline 5 days after the operation, and the waist line had been worn for 3 weeks. The clinical results were evaluated using the oswetry disability index （ ODI ） and visual analogue scale （ VAS ） scores. The maintenance of intervertebral motion function, the disc space height and the range of motion （ ROM ） of proximal adjacent segments in non-fusion segments were evaluated by the dynamic lateral X-rays. Results The mean follow-up time was 24.7 months （ range; 10-36 months ）. The preoperative and postoperative ODI scores were （ 60.4±21.5 ） % and （ 23.9±13.5 ） % respectively （ P〈0.05 ）. The preoperative and postoperative VAS scores of back pain were 6.0~1.8 and 2.1±1.7 respectively （ P〈0.05 ）, and the preoperative and postoperative VAS scores of leg pain were 7.2±1.9 and 1.9±1.1 respectively （P〈0.05）. The clinical results were satisfactory. The average ROM of the intervertebral body of non-fusion segments was 3.7~ （ range; 2o-5~ ） based on the radiographic evaluation. Conclusions The preliminary clinical results of the Dynesys dynamic fixation system in the treatment of lumbar degenerative disease were satisfactory, which can partially retain the motion function of fixed segments. It is an alternative choice in the treatment of degenerative lumbar stenosis and degenerative disc disease.