小切口经椎旁肌间隙入路置入动态中和固定系统治疗腰椎退行性疾病的近期疗效

目的评价采用后正中小切口经椎旁肌间隙入路(Wiltse入路)置入动态中和固定系统(Dynesys)治疗腰椎退行性疾病的近期临床疗效。方法本研究共纳入我院2010年8月～2011年8月采用后正中小切口经Wiltse入路置入Dynesys系统治疗腰椎退行性疾病患者39例,男性22例,女性17例;年龄39～60岁,平均46岁。通过视觉模拟评分法(VAS)、Oswestry功能障碍指数(ODI)评分,以及对术前、术后的腰椎正侧位、过伸过屈位片测量椎间角度,计算椎间角度位移(ROM),进而评价其疗效。结果术后末次随访时的VAS评分、ODI评分均较术前显著降低(P<0.05),末次随访时手术节段的椎间角度位移(ROM)显著减少(P<0.05),手术相邻节段的术前ROM与末次随访时的ROM比较无明显差异(P>0.05)。结论 Dynesys系统治疗腰椎退行性疾病疗效明显,且对邻近节段无显著影响。后正中小切口经Wiltse间隙置入Dynesys内固定系统,具有创伤小、恢复快、平均住院时间短、避免术后肌肉疼痛等优点。

Initial clinical effects of dynamic neutralization system through paraspinal approach for the treatment of degenerative lumbar diseases

Objective To evaluate the initial clinical effects of dynamic neutralization system（Dynesys） through paraspinal approach for the treatment of degenerative lumbar diseases. Methods Thirty-nine consecutive patients with degenerative lumbar diseases were treated with implantation of Dynesys by paraspinal approach between Aug. 2010 and Aug. 2011. All the patients were evaluated by the visual analogue scale （ VAS ） , score of the Oswestry Disability Index（ ODI ）, radiography before and after operation, and range of motion （ ROM ）were calculated. Re- suits The mean preoperative VAS was 7.23 ± O. 96, and the postoperative VAS was 1.72±0.51. The mean ODI score was reduced from （ 57.28 ±5.28 ） % preoperatively to （ 15.69± 1.32 ） % postoperatively. Compared with preoperation, the postoperative VAS and ODI decreased significantly （ P 〈 0.05 ）. Furthermore, there were statisti- cally significant changes in the ROM at the stabilized segments（P 〈 O. 01 ） , but no significant changes were seen at the adjacent segments （ upper and lower segments, P 〉 0.05 ）. Conclusion The Dynesys system instrumentation has good effects in initial clinical application,can preserve the motion of stabilized segments and retain the integrity of anatomic structure, maintain the stability of stabilized segments. This system also has no adverse effects on adjacent segments, and has advantages of less intraoperative injuries , quick recovery, shorter hospitalication time, and less postoperative muscle pain.