Dynesys动态稳定系统治疗多节段腰椎退变性疾病的中远期临床疗效观察

目的:探讨Dynesys动态中和内固定系统治疗多节段腰椎退变性疾病的中远期临床疗效。方法:对2008年12月至2011年5月采用Dynesys系统治疗的多节段腰椎间盘突出症和多节段腰椎管狭窄症28例患者进行回顾性分析。其中男16例,女12例;年龄27～75岁,平均49.1岁。多节段腰椎间盘突出症13例,L₃-L₅ 7例,L₂-L₄ 1例,L₄-S₁ 5例;多节段腰椎管狭窄症15例,L₃-L₅ 10例,L₂-L₅ 4例,L₂-S₁ 1例。所有患者腰腿痛和(或)间歇性跛行症状经正规保守治疗6个月以上无效。记录手术前后患者的腰腿部疼痛视觉模拟评分(Visual analogue scale,VAS),通过影像学资料观察固定节段及头侧邻近节段的椎间隙高度和椎间活动度,采用Oswestry功能障碍指数(Oswestry Disability Index,ODI)对疗效进行评定。结果:28例患者均顺利完成手术,且均获得随访,随访时间38～65个月,平均50.6个月。末次随访时腰腿痛VAS评分分别为1.25±0.70和1.29±0.89,ODI为(25.10±6.52)%,腰腿痛VAS评分及ODI较术前有明显下降(p<0.05).术后随访固定节段椎间隙高度较术前有所升高,椎间活动度下降,与术前比较差异有统计学意义(p<0.05).术前及术后各随访时间点头侧邻近节段活动度、椎间隙高度差异无统计学意义(p>0.05).结论:Dynesys治疗多节段腰椎退变性疾病中远期临床疗效满意,能保留部分椎间活动度,对邻近节段影响小。Dynesys远期临床疗效还有待更长时间的随访观察。

Long-term follow-up of Dynesys system in clinical application for the treatment of multiple lumbar degenerative disease

Objective:To explore the clinical effects of Dynesys system for the treatment of multiple segment lumbar degenerative disease. Methods:A total of 28 patients with lumbar degenerative disc disease treated with Dynesys system from December 2008 to May 2011 were retrospectively reviewed. There were 16 males and 12 females,aged from 27 to 75 years old with an average of 49.1 years. Thirteen patients with multiple segmental lumbar intervertebral disc protrusion,including L₃-L₅ in 7 cases,L₂-L₄ in 1 case and L₄-S₁ in 5 cases. Fifteen patients with multiple segmental lumbar spinal stenosis,including L₃-L₅ in 10 cases,L₂-L₅ in 4 cases and L₂-S₁ in 1 case. The symptoms of lumbago and (or) intermittent claudication in all patients were treated with conservative treatments for more than 6 months and these methods did not work. Visual analogue scale (VAS) was used to analyze the lumbar and leg pain,imaging data were used to measure the intervertebral space height and intervertebral motion of fixed segment and upper adjacent segment,Oswestry Disability Index (ODI) was used to evaluate the clinical effect. Results:All operations were successful and the patients were followed up from 38 to 65 months with an average 50.6 months. At final follow-up,ODI and VAS of the low back pain and leg pain were (25.10±6.52)%,( 1.25±0.70) points and (1.29±0.89) points,respectively and were decreased compared with preoperative(p<0.05). Postoperative intervertebral space heights were increased and intervertebral motions were decreased in fixed segment compared with preoperative(p<0.05). There were no significant differences in intervertebral space heights and intervertebral motions of upper adjacent segment between preoperative and postoperative(p>0.05). Conclusion:Dynesys system may obtain long-term clinical curative effect in treating multiple lumbar degenerative disease. It can partially preserve the intervertebral motions of the fixed segments,have little effect on adjacent segments. The long-term clinical effect of Dynesys still need longer time follow-up observation.