后路动态稳定系统内固定治疗腰椎间盘突出症的稳定性评价

背景：后路动态稳定系统可以用来保留椎体运动节段，减少椎体相邻节段的退变。目的：探讨后路动态稳定系统对腰椎间盘突出症治疗的中期疗效和稳定性。方法：选取首都医科大学附属北京世纪坛医院骨科2009年2月至2011年6月的18例退行性腰椎疾病患者在后路减压的同时行后路动态稳定系统内固定。男11例，女7例；年龄32—67岁，平均年龄45岁。应用目测类比评分进行疼痛评估，以Oswest功能障碍指数进行临床疗效评价，应用过屈过伸位X射线测量后路动态稳定系统内固定后腰椎间盘和相邻间盘活动度。结果与结论：所有患者随访时间20-45个月，平均随访38个月。目测类比评分后路动态稳定系统内固定治疗前7．1—9．4分，平均得分8．3分，内固定治疗后0—3．1分，平均得分1．5分，目测类比评分改善率为81．5％。Oswest功能障碍指数在后路动态稳定系统内固定治疗前35-81分（平均60分），内固定治疗后0—45分（平均22分），功能障碍恢复率为63．3％。后路动态稳定系统内固定治疗后1例出现松动，1例出现下肢神经症状一过性加重，3个月后逐渐缓解。腰椎间盘在内固定后平均活动度为5．3°。后路动态稳定系统治疗腰椎间盘突出症可以保留固定节段的活动度和稳定性，中期临床症状恢复良好，说明该系统是治疗腰椎间盘突出症的一种可供选择的非融合性固定方法，但其对相邻节段的影响尚需要进行长期随访。

Stability of posterior dynamic stabilization system fixation for the treatment of lumbar disc herniation

BACKGROUND： Posterior dynamic stabilization system can be used to maintain the vertebral motion segment and reduce the degeneration of vertebral body adjacent segment. OBJECTIVE： To investigate the efficacy and stability of posterior dynamic stabilization system for the treatment of lumbar disc herniation. METHODS： Eighteen patients with degenerative lumbar disease and treated with posterior decompression and posterior dynamic stabilization system internal fixation in the Department of Orthopedics, Beijing Shijitan Hospital Affiliated to Capital Medical University from February 2009 to June 2011 were selected, included 11 male patients and seven female patients, the age was 32-67 years old and averaged in 45 years old. The visual analogue scale score was used for pain assessment and the Oswestry disability index was used for clinical evaluation, the flexion and hyperextension X-ray films were used to measure the activity of lumbar intervertebral disc and the adjacent intervertebral disc after posterior dynamic stabilization system fixation. RESULTS AND CONCLUSION： All the patients were followed-up for 20-45 months, averaged in 38 months. The visual analogue scale score before posterior dynamic stabilization system fixation was 7.1-9.4 points, and averaged 8.3 points, the postoperative score was 0-3.1 points, averaged 1,5 points, the improvement rate of visual analogue scale score was 81.5%. The Oswestry disability index before posterior dynamic stabilization system fixation was 35-81 points （average 60 points） and 0-45 points after fixation （average 22 points）, and the improvement rate of Oswestry disability index was 63.3%. There was one case of loosening after posterior dynamic stabilization system fixation, one case had lower extremity nerve symptoms transient increasing and relieved after 3 months. The average range of motion after fixation was 5.3~. The posterior dynamic stabilization system for the treatment of lumbar disc herniation can maintain the range of motion and stability of the fixed segment with well recovered medium-term clinical symptoms, suggesting that this system is an alternative non-fusion fixation method for the treatment of lumbar disc herniation, but the effect on the adjacent segment still need to be identified with long-term follow-up.