Dynesys动态稳定系统与植骨融合术治疗退变性腰椎不稳近期临床疗效分析

发布时间：2018-05-05 05:14

本文选题：Dynesys + 植骨融合内固定术　；参考：《成都中医药大学》2015年硕士论文

【摘要】：背景：植骨融合内固定已被认为是治疗退变性腰椎不稳金标准,但术后邻近节段退变问题越来越受关注。在此背景下,非融合技术应用于临床。目的：回顾性分析和对比Dynesys动态稳定系统和后路植骨融合内固定术治疗退变性腰椎不稳的患者的近期临床疗效及影像学资料,评价近期临床疗效及末次随访邻近节段退变。方法：回顾分析我科室2012年12月至2014年5月期间收治经手术治疗腰椎退变性不稳患者28例,采用椎管减压结合椎弓根动态稳定系统(观察组,Dynesys, A组,14例)与后路减压椎间融合术(对照组,PLIF,B组,14例),记录两组患者术前、术后1月、3月、6月、12月及末次随访疼痛视觉模拟评分(Visual Analogue Scale/Score,简称VAS)、0swestry功能障碍指数评分(0DI评分)并且收集术前及随访时腰椎正侧位片及动力位片,采用White邻近节段退变判断标准,评价末次随访影像学ASD,对所得数据进行统计学SPSS17.0分析。结果：所有患者都得到随访,平均随访18±3.4个月。两组患者术后1月、3月、6月、12月及末次随访VAS评分、ODI评分均较术前明显改善,均有显著统计学差异(P0.05)；两组患者术后各时间段VAS评分、ODI评分对比无统计学差异(P0.05)；末次随访观察组影像学ASD 1例；对照组邻近节段影像学退变者4例,观察组末次随访ASD发病率更低,两者对比有统计学差异(P0.05)。结论：1、Dynesys动态稳定系统治疗退变性腰椎不稳相比于传统植骨融合内固定术近期临床疗效相当；可提供腰椎稳定性,改善临床症状；2、Dynesys动态稳定系统能保留运动节段部分活动度,明显降低影像学ASD发病率,临床上治疗腰椎退变性不稳可推广使用。
[Abstract]:Background: bone graft fusion and internal fixation have been regarded as the gold standard for the treatment of degenerative lumbar instability. In this context, non-fusion techniques are applied in clinical practice. Objective: to retrospectively analyze and compare the short-term clinical effect and imaging data of patients with degenerative lumbar spine instability treated by Dynesys dynamic stabilization system and posterior bone graft fusion and internal fixation. Methods: from December 2012 to May 2014, 28 cases of lumbar degenerative instability were treated with surgical treatment. Spinal canal decompression combined with pedicle dynamic stabilization system (observation group, n = 14) and posterior decompression and interbody fusion (control group, n = 14) were used to record the patients before operation. Visual Analogue scale / Score.Visual Analogue scale score of visual analogue score (VAS / 0 swestry dysfunction index) was followed up at 1 month, 3 months, 6 months, 12 months and the last follow-up. The anterior and lateral lumbar vertebrae films and dynamic position films were collected before and after follow-up, and the White adjacent segment degeneration criteria were used. To evaluate the last follow-up imaging ASD, the data were analyzed by SPSS17.0. Results: all patients were followed up for an average of 18 卤3.4 months. The VAS scores were significantly improved in both groups at 1 month, 3 months, 6 months, 12 months and the last follow-up. There were significant statistical differences between the two groups (P 0.05), there was no significant difference in VAS scores between the two groups at each time after operation (P 0.05), the imaging ASD in the last follow-up group (n = 1) and the control group (n = 4) had degenerative changes in the adjacent segment, and there was no significant difference between the two groups (P < 0.05). The incidence of ASD in the last follow-up group was lower than that in the control group (P 0.05). Conclusion compared with traditional bone graft fusion and internal fixation, the dynamic stabilization system of dystroy of degenerative lumbar vertebrae can provide stability of lumbar vertebrae and improve the clinical symptoms of dyesys dynamic stabilization system, which can preserve the motion degree of degenerative lumbar vertebrae, and it is effective in the treatment of degenerative lumbar vertebrae instability. The incidence of imaging ASD was significantly reduced and the clinical treatment of lumbar degenerative instability could be popularized.
【学位授予单位】：成都中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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