Dynesys系统治疗腰椎疾病的长期临床疗效观察

目的评估Dynesys系统治疗腰椎退变性疾病的长期临床安全性和有效性。方法回顾自2006年1月至2010年6月于本院实施Dynesys系统植入术患者共43例，男18例，女25例，年龄35～70岁，平均52．2岁，其中单纯退行性腰椎管狭窄者21例，腰椎管狭窄并椎间盘突出者15例，腰椎管狭窄伴退行性腰椎滑脱（I度滑脱）者5例，复发性腰椎间盘突出者2例，均经非手术治疗无效，于我院植入Dynesys系统。以疼痛视觉模拟评分（visual analoguescale，VAS）、Oswestry功能障碍指数评分（oswestry disability index，ODI）、椎间隙高度、椎间活动度（rangeofmotion，ROM）进行疗效评估；采用NASS指数评估患者满意度；观察患者行走距离、术后固定及邻近节段退变、并发症发生情况等。结果本组病例全部获得随访，时间27～54个月，平均39．5个月。术后3个月患者的腰痛VAS评分、腿痛VAS评分、ODI评分分别由术前的7．67分、6．77分、60．58分下降到2．93分、2．32分、26．02分（P〈0．01）；椎间隙高度由术前的9．73mm升高到12．50mm（P〈0．01）；步行距离由术前的10～1000m升高到均大于1000m；ROM值由术前的7．80。下降到5．26。（P〈0．01）。术后随访期间各时间点之间腰痛VAS评分、腿痛VAS评分、ODI评分、椎间隙高度、ROM值均无显著性差异（P〉0．05），而与术前相比差异均有统计学意义（P〈0．01）。UCLA系统评价显示术后及随访期间固定节段及相邻节段未出现进一步退变。术中、术后及随访期间均未出现严重并发症。结论Dynesys系统对腰椎退变性患者具有良好的长期临床疗效，安全性高，值得进一步推广。

Clinical Effect of Dyenesys in Treatment of Lumbar Spine Disease

Objective The aim of this project is to assess the long-term clinical safety and effectiveness of dynamic neutralization system（oynesys） in treating lumbar degenerative diseases. Methods 43 patients undernented dynamic neutralization system implantation from January 2006 to June 2010 were reviewed. There were 18 male and 25 female. The ages ranged from 35 to 70 with an average of 52.2 years old. There were 21 patients of degenerative lumbar spinal stenosis, 15 patients of lumbar spinal stenosis with intervertebral disc herniation,5 patients of lumbar spinal stenosis with degenerative lumbar （degree 1 ） and 2 patients of Index recurrent lumbar disc herniation. Visualanalogue scale （VAS） ,oswestry disability index （ODI） ,intervertebral disc height and range of motion （ROM） to evaluate the clinical effect and North American Spine Society （NASS） was used to assess the satisfaction of patients. The walking distance, fixation and adjacent segment degeneration and complica- tion of patients after surgery were observed. Results All patients were followed-up for 27 to 54 months with an average time 39.5 month. The back pain VAS,leg pain VAS and ODI decreased from 7.67,6.77,60.58 before sugary to 2.93,2.32,26.02 after sugary （ P 〈 0.01 ） ; intervertebral disc height raised from 9.73 mm to 12.50 mm （ P 〈 0.01 ） ; walking distance raised from 10 - 1 000 m to more than 1 000 m and ROM dropped from 7.80 ° to 5.26 ° （ P 〈 0.01 ）. The VAS of back and leg pain, the ODI,intervertebral disc height and ROM showed no significant differences during the follow-up period （ P 〉 0.05 ） and showed significane difference compared with that before sugary （P 〈0.01 ）. The UCLA（ University of California at Los Angeles） Grading Scale evaluation showed no further degeneration of fixed segments and adjacent segments after sugary and follow- up period and no serious complications were observed. Conclusion Dynamic neutralization system has good long-term clinical effects and safety and worth to be popularized.