Dynesys动态固定系统用于腰椎多节段退行性疾病的2年随访临床疗效观察

发布时间：2018-05-09 15:50

本文选题：腰椎退行性疾病 + 多节段　；参考：《第三军医大学学报》2017年11期

【摘要】：目的通过对比分析评估Dynesys动态固定系统与融合术在腰椎多节段退行性疾病治疗中的临床疗效及对腰椎运动功能的影响。方法收集2013年1月至2014年5月在我院行多节段Dynesys动态固定及融合术的51例患者的临床资料,其中Dynesys动态固定组24例,融合组27例。应用腰椎疼痛视觉模拟指数评分(visual analogue scale,VAS)、腰椎功能评分(oswestry disability index,ODI)评估临床疗效;对比分析两种术式术前及术后6、12、24个月腰椎整体活动度、手术节段活动度、邻近第一椎间活动度、邻近第一椎间高度、邻椎病(adjacent segment disease,ASD)的发生率,评估两种术式对腰椎运动功能的影响。结果 51例患者均获得完整随访,平均随访26.2(23~31)个月。两组病例VAS评分及ODI评分术后各时间点与术前相比均明显下降,差异有统计学意义(P0.05),术后6个月组间比较差异有统计学意义(P0.05),其余各时间点组间比较差异无统计学意义。Dynesys动态固定组术后较融合组保留了更多的腰椎整体活动度,差异有统计学意义(P0.01)。Dynesys动态固定组术后保留了部分手术节段的活动度,融合组因融合而丢失活动度,组间比较差异有统计学意义(P0.01)。术后24个月两组病例邻近上一椎间活动度差异有统计学意义(P0.01),邻近上一椎间高度组间及组内各时间点比较差异无统计学意义。在ASD方面,融合组3例出现邻近节段不稳,但无明显临床症状,未行临床干预。结论 Dynesys动态固定系统治疗腰椎多节段退行性疾病具有良好的临床疗效,同时保留了更多的活动度,减缓ASD的发生,可以作为一种较好的手术治疗选择。
[Abstract]:Objective to evaluate the clinical effect of Dynesys dynamic fixation system and fusion in the treatment of lumbar multilevel degenerative disease and its effect on lumbar motor function. Methods the clinical data of 51 patients with multilevel Dynesys dynamic fixation and fusion were collected from January 2013 to May 2014 in our hospital, including 24 cases in Dynesys dynamic fixation group and 27 cases in fusion group. The visual analogue index of lumbar pain (VAS) was used to evaluate the clinical efficacy of lumbar spine function score (LFS) and the lumbar function score (LFS) was used to evaluate the clinical efficacy, and to compare and analyze the whole motion of lumbar vertebrae before and after operation in 612,24 months, the range of motion of operation segment, and the range of motion of adjacent first vertebrae. To evaluate the effect of two surgical procedures on lumbar motor function, the incidence of adjoining segment disease (ASD) adjacent to the first intervertebral height was evaluated. Results all the 51 patients were followed up for an average of 26.2 months. The VAS score and ODI score in both groups were significantly lower than those before operation. The difference was statistically significant (P 0.05), and there was significant difference between the groups 6 months after operation (P 0.05). There was no significant difference between the other time points. The dyesys dynamic fixation group retained more lumbar vertebrae motion than the fusion group. The difference was statistically significant (P 0.01) .Dynesys dynamic fixation group retained the motion of some segments after operation, and the fusion group lost the range of motion due to fusion, and the difference between the two groups was statistically significant (P 0.01). 24 months after operation, there was significant difference in the activity of the adjacent upper vertebra between the two groups (P 0.01), but there was no significant difference between the groups adjacent to the upper intervertebral height and each time point within the group. In ASD, there were 3 cases of adjacent segment instability in fusion group, but no obvious clinical symptoms and no clinical intervention. Conclusion Dynesys dynamic fixation system has a good clinical effect in the treatment of lumbar multilevel degenerative diseases, and it can be used as a better choice of surgical treatment for the patients with multiple lumbar degenerative diseases, while retaining more range of motion and slowing down the occurrence of ASD.
【作者单位】：第三军医大学西南医院全军矫形外科中心组织工程国家地方联合工程实验室全军骨组织工程重点实验室;
【基金】：第三军医大学临床重大课题(2012XLC01) 中国健康促进基金会课题(WX2015-006)~~
【分类号】：R687.3

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