动态中和系统（Dynesys）与后路椎间融合术治疗腰椎退行性疾病的临床疗效对比分析

发布时间：2018-09-03 10:24

【摘要】：目的:通过临床对比,分析研究动态中和系统(Dynesys)和后路脊柱融合术在治疗腰椎退变性疾病中的疗效,进一步指导两种术式在临床中的选用。方法:选我院自2012年3月到2012年10月间收入院并行手术治疗的腰椎退变性疾病患者30例,其中采用Dynesys术式(以下称为观察组)的患者15例,采取后路脊柱融合术(以下称为对照组)的15例,随访时间均大于20个月,术前测量并记录目前国内外比较流行的观测指标,将其和术后末次随访时的纪录值进行回顾性分析。结果:2组研究对象在病例数量、性别、年龄、疾病类型、随访时间等基线资料分析差异无统计学意义(p㧐0.05),具有同质性;两组手术时间、术中出血量比较差异有统计学意义(p㩳0.05),观察组优于对照组;两组术后末次随访疼痛视觉模拟评分(Visual analogue scale,VAS)、Oswestry功能障碍指数评分(Oswestry disability index,ODI)与术前比较均有较大改善,差异有统计学意义(p㩳0.05),但两组间比较差异无统计学意义(p㧐0.05);两组术后末次随访手术节段椎间隙高度均较术前增加,但两组比较差异无统计学意义(p㧐0.05);两组术后临近节段椎间隙高度增加,与术前相比均有统计学意义(p㩳0.05),但观察组优于对照组;术后末次随访,对照组已骨性愈合,手术节段椎间活动度(Range of motion,ROM)为0°,而观察组保留部分椎间活动度,差异有统计学意义(p㩳0.05)。观察组临近节段ROM较术前减小,差异无统计学意义(p㧐0.05),对照组临近节段ROM较术前明显增加,差异有统计学意义(p㩳0.05)。结论:在近期疗效对比上,Dynesys和后路脊柱融合术差别不大,临床上都取得了不错的疗效,患者术后症状较术前均得到明显缓解,但Dynesys内固定可以部分保留手术节段ROM,可减少因手术节段固定而导致的邻近节段代偿性活动增大,进而延缓临近节段椎间盘的退变,且可以缩短手术时间、减少出血量。把握好适应症的前提下,在临床上值得进一步推广应用。
[Abstract]:Objective: to evaluate the efficacy of dynamic neutralization system (Dynesys) and posterior spinal fusion in the treatment of lumbar degenerative diseases. Methods: from March 2012 to October 2012, 30 patients with lumbar degenerative diseases admitted to our hospital for surgical treatment, 15 of them were treated with Dynesys (observation group). Fifteen cases of posterior spinal fusion (hereinafter referred to as the control group) were followed up for more than 20 months. The current domestic and foreign popular observation indexes were measured and recorded before operation, and the values recorded at the last follow-up were analyzed retrospectively. Results there was no significant difference in baseline data analysis between the two groups (p0.05) in terms of the number of cases, sex, age, disease type and follow-up time (p0.05), and there was no significant difference between the two groups in terms of the number of cases, sex, age, disease type and follow-up time (p0.05). The difference of intraoperative bleeding volume was statistically significant (p0.05), the observation group was superior to the control group, the last follow-up pain visual analogue score (Visual analogue scale,VAS) and the Oswestry dysfunction index score (Oswestry disability index,ODI) in the two groups were significantly improved compared with those before operation. The difference was statistically significant (p0. 05), but there was no significant difference between the two groups (p0. 05). However, there was no significant difference between the two groups (p0.05), the height of adjacent intervertebral space increased after operation in both groups (p0.05), but the observation group was superior to the control group. (Range of motion,ROM was 0 掳, while the observation group retained part of the intervertebral movement, the difference was statistically significant (p0. 05). The ROM in the adjacent segment of the observation group was lower than that in the preoperative group (p0. 05), and the ROM in the adjacent segment of the control group was significantly higher than that in the control group (p0. 05). Conclusion: there is no significant difference between dyesys and posterior spinal fusion in the short term. But Dynesys internal fixation can partially preserve the operative segment ROM, can reduce the adjacent segment compensatory activity increase caused by the surgical segment fixation, and then delay the degeneration of the adjacent segment intervertebral disc, and can shorten the operation time and reduce the amount of bleeding. Under the premise of grasping the indication, it is worth further popularizing and applying in clinic.
【学位授予单位】：河南中医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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