| 摘要: |
| 目的 通过对比Dynesys动态固定与融合固定治疗腰椎退变性疾病的疗效,评价Dynesys动态固定在治疗腰椎退变性疾病中的应用价值。方法 回顾性分析2009年6月至2010年6月在第二军医大学长海医院接受手术治疗的腰椎退变性疾病患者60例,按动态固定和融合固定分组。接受Dynesys动态内固定的患者26例,男性15例、女性11例,年龄 (42.45±10.12)岁 (32~56岁),突出节段： L4~L5节段13 例,L5~S1节段13例。接受脊柱融合手术的患者34例,男性20例、女性14 例,年龄(45.24±12.15)岁(38~60岁),突出节段： L4~L5节段18例, L5~S1节段16例。比较两组手术时间、术中出血量、住院天数,术前及末次随访时的Oswestry功能障碍指数(ODI)、腰腿疼痛视觉模拟评分(VAS)和健康状况调查问卷(SF-36)等临床评分结果以及腰椎活动度、椎间隙高度变化情况。结果 所有患者全部获得随访,随访时间3~4年,平均随访(3.2±0.2)年。两组在手术时间、术中出血量方面差异有统计学意义(P<0.05),平均住院天数差异无统计学意义。末次随访时患者的ODI、VAS、SF-36临床评分均较术前有明显改善(P<0.01),Dynesys组相比融合组改善明显(P<0.01)。末次随访时两组腰椎活动度均较术前无明显变化,两组间腰椎活动度比较差异无统计学意义；末次随访时两组椎间隙高度均较术前无明显丢失,两组间椎间隙高度比较差异无统计学意义。结论 Dynesys动态固定在影像学结果方面与融合组相比较优势并不显著,在相邻节段退变方面,也没有明确的证据显示融合固定比Dynesys动态固定更容易发生相邻节段退变。但是临床评分结果相比,Dynesys动态固定改善得更多,另外Dynesys动态固定还具有出血少、手术时间短等优点,对中老年患有腰椎退变性疾病的患者,Dynesys动态固定是一个可以接受的选择。 |
| 关键词: Dynesys动态稳定系统 腰椎融合固定 腰椎退变性疾病 |
| DOI：10.3724/SP.J.1008.2014.01145 |
| 投稿时间：2014-01-09修订日期：2014-03-26 |
| 基金项目: |
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| Dynesys dynamic fixation and lumbar spinal fusion for treatment of lumbar degenerative disease: a clinical comparative study |
| YANG Feng,HE Da-wei*,ZHU Xiao-dong,LI Jing-feng |
(Department of Orthopaedics, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
*Corresponding authors) |
| Abstract: |
| Objective To evaluate the value of Dynesys dynamic fixation for treatment of lumbar degenerative disease by comparing with lumbar spinal fusion. Methods The clinical data of 60 patients with lumbar degenerative disease, who were treated in Changhai Hospital from June 2009 to June 2010, were retrospectively analyzed. Twenty-six patients, including 15 males and 11 females, with age ranging 32-56 years (average [42.45±10.12] years), received Dynesys implantation for segments L4-L5 (13 cases) and L5-S1 (13 cases). Thirty-four patients, including 20 males and 14 females, with age ranging 38-60 years(average [45.24±12.15] years), received fusion implantation for segments L4-L5 (18 cases) and L5-S1 (16 cases). The following parameters were observed and compared between the two groups: operation time, blood loss, hospital stay, preoperative Oswestry disability index (ODI), ODI at last follow-up, low back and leg pain visual analogue scale (VAS), results of health status questionnaire (SF-36), segmental angulation degree of lumbar spine, and intervertebral height. Results All the 60 patients were followed up for 3-4 years (average [3.2±0.2] years). The operation time and intra-operative blood loss were significantly different between the two groups (P<0.05), and no difference was found for average hospital days. The ODI, VAS, and SF-36 clinical scores at last follow-up were significantly improved compared with those before operation in the two groups (P<0.01), with the improvement in Dynesys group being more significant than the fusion group (P<0.01). The segmental angulation degree of lumbar spine had no noticeable improvement in the two groups at last follow-up, and there were no significant differences between the two groups. There was no intervertebral height loss at the last follow-up in the two groups, and there was no significant difference in intervertebral heights between the two groups. Conclusion Dynesys dynamic lumbar fixation shows no more advantages in terms of radiological results compared with the fusion group. Moreover, fusion fixation is not suggested to have more adjacent segment degeneration(ASD) than Dynesys dynamic lumbar fixation. But clinically Dynesys dynamic lumbar fixation yields a greater improvement, with the advantages of less bleeding and shorter operation time. In middle-aged and elderly patients with degenerative diseases, Dynesys dynamic lumbar fixation is an acceptable choice. |
| Key words: Dynesys dynamic stabilization lumbar fusion lumbar spine degenerative disease |
