Dynesys动态中和系统治疗腰椎退行性疾病的临床疗效及影像学分析
发布时间：2018-09-17 07:38
【摘要】：目的观察Dynesys动态中和系统治疗腰椎退行性疾病的早期临床疗效;分析Dynesys动态固定术后腰椎节段的放射学变化;通过对残留椎间盘的再水化现象分析初步探讨Dynesys动态固定对退变椎间盘的修复作用。方法:回顾性分析2011年12月至2013年10月在我院接受手术治疗的89例腰椎间盘退行性疾病患者资料,按手术方式分为Dynesys动态固定组(Dynesys dynamic fixation,Dynesys组)与后路腰椎间融合组(posterior lumbar interbody fusion,PLIF组),其中Dynesys组38例,男性27例,女性11例,平均(37.66±9.58)岁;PLIF组51例,男性35例,女性16例,平均(40.53±11.72)岁。评估两组患者术前及末次随访时腰腿痛VAS、ODI评分,采用腰椎X片测量手术节段及邻近节段椎间隙前后方高度、屈伸活动度(range of motion,ROM)及腰椎前凸角(L1-L5);利用腰椎MRI计算手术节段椎间盘平均标准椎间盘信号(calibrated disc signal,CDS)。结果:89例患者术后随访14月~37月,平均(25.11±6.96)个月。所有患者均在末次随访时复查腰椎X线,Dynesys组中23例病人末次随访时获得腰椎MRI复查。末次随访时,两组患者腰腿痛VAS评分和ODI指数较术前均有明显改善(P0.05)。与术前相比,Dynesys组手术节段椎间隙前、后缘高度明显降低(P0.05);两组上位邻近节段椎间隙前缘高度无显著变化(P0.05),但后缘高度均显著丢失(P0.05);两组下位邻近节段椎间隙前后缘高度及腰椎前凸角均无明显改变。末次随访Dynesys组手术节段屈伸ROM(2.90±1.72)°比术前(5.31±2.60)°明显减少(P0.05),但仍保留术前ROM的64.11%,上下相邻节段及腰椎整体ROM较术前无统计学差异;而PLIF组上位相邻节段ROM由术前(5.64±2.79)°明显增加至(7.76±3.15)°,存在统计学差异(P0.05),下位相邻节段及腰椎整体ROM较术前无显著变化(P0.05)。Dynesys组中23名患者接受腰椎MRI复查,平均CDS由术前42.74%±13.15%改善至47.69%±14.38%,差异有统计学意义(P=0.004)。结论:与融合术相比,Dynesys动态中和系统同样是一种有效的、可选择的治疗腰椎退行性疾病的手术方式;Dynesys系统保留了固定节段一定ROM,不引起邻近节段过度活动;同时,残留椎间盘出现再水化,表明其可能具有促进退变椎间盘修复的作用。但是,Dynesys非融合术后存在明显的手术节段椎间隙高度丢失以及上位邻近节段代偿性前凸等问题,有待进一步长期随访观察。
[Abstract]:Objective to observe the early clinical effect of Dynesys dynamic neutralization system in the treatment of lumbar degenerative diseases and to analyze the radiologic changes of lumbar segment after Dynesys dynamic fixation. By analyzing the rehydration phenomenon of residual intervertebral disc, the effect of Dynesys dynamic fixation on the repair of degenerative intervertebral disc was preliminarily discussed. Methods: the data of 89 patients with degenerative lumbar disc disease who received surgical treatment in our hospital from December 2011 to October 2013 were analyzed retrospectively. The patients were divided into two groups according to the operative method: (Dynesys dynamic fixation,Dynesys group (n = 38) and (posterior lumbar interbody fusion,PLIF group (n = 16). There were 38 cases of Dynesys group (male 27 cases, female 11 cases, mean (37.66 卤9.58) years old) 51 cases (male 35 cases, female 16 cases, mean 40.53 卤11.72 years old). The VAS,ODI score of lumbago and leg pain was evaluated before and at the last follow-up in both groups. The anterior and posterior height of the surgical segment and adjacent intervertebral space were measured by lumbar X ray. Flexion and extension (range of motion,ROM) and Lumbar kyphosis (L1-L5), and MRI was used to calculate the mean signal (calibrated disc signal,CDS of lumbar intervertebral disc. Results the follow-up of 89 cases was from 14 months to 37 months, with an average of (25.11 卤6.96) months. All the patients received lumbar MRI reexamination at the last follow-up in 23 patients in the lumbar X-ray Dynesys group. At the last follow-up, the VAS score and ODI index of lumbago and leg pain in both groups were significantly improved compared with those before operation (P0.05). Compared with before operation, the segmental intervertebral space in Dynesys group was preoperatively. The posterior edge height was significantly decreased (P0.05); there was no significant change in the anterior edge height of upper adjacent segments in both groups (P0.05), but the posterior edge height was significantly lost (P0.05); the anterior and posterior edge height and lumbar lordosis angle were not significantly changed in the two groups. In the last follow-up Dynesys group, the flexion and extension ROM (2.90 卤1.72) 掳decreased significantly compared with the preoperative (5.31 卤2.60) 掳(P0.05), but the preoperative ROM was retained at 64.11%. There was no significant difference between the upper and lower adjacent segments and the whole ROM of the lumbar vertebrae. In the PLIF group, the upper adjacent segment ROM increased from (5.64 卤2.79) 掳to (7.76 卤3.15) 掳, there was statistical difference (P 0.05). There was no significant change in the inferior adjacent segment and lumbar whole ROM compared with the preoperative (P0.05). The 23 patients in the dyesys group received MRI reexamination of lumbar vertebrae. The average CDS was improved from 42.74% 卤13.15% to 47.69% 卤14.38% (P0. 004). Conclusion: compared with fusion, dynesys dynamic neutralization system is also an effective method for the treatment of lumbar degenerative diseases. The Dynesys system retains a fixed segment of ROM, and does not cause hyperactivity in adjacent segments. The rehydration of the residual intervertebral disc suggests that it may promote the repair of degenerative intervertebral disc. However, the loss of height of intervertebral space and the compensatory protruding of superior adjacent segment after Dynesys non-fusion surgery are obvious problems, which need to be followed up for a long time.
【学位授予单位】：暨南大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
本文编号：2245183
[Abstract]:Objective to observe the early clinical effect of Dynesys dynamic neutralization system in the treatment of lumbar degenerative diseases and to analyze the radiologic changes of lumbar segment after Dynesys dynamic fixation. By analyzing the rehydration phenomenon of residual intervertebral disc, the effect of Dynesys dynamic fixation on the repair of degenerative intervertebral disc was preliminarily discussed. Methods: the data of 89 patients with degenerative lumbar disc disease who received surgical treatment in our hospital from December 2011 to October 2013 were analyzed retrospectively. The patients were divided into two groups according to the operative method: (Dynesys dynamic fixation,Dynesys group (n = 38) and (posterior lumbar interbody fusion,PLIF group (n = 16). There were 38 cases of Dynesys group (male 27 cases, female 11 cases, mean (37.66 卤9.58) years old) 51 cases (male 35 cases, female 16 cases, mean 40.53 卤11.72 years old). The VAS,ODI score of lumbago and leg pain was evaluated before and at the last follow-up in both groups. The anterior and posterior height of the surgical segment and adjacent intervertebral space were measured by lumbar X ray. Flexion and extension (range of motion,ROM) and Lumbar kyphosis (L1-L5), and MRI was used to calculate the mean signal (calibrated disc signal,CDS of lumbar intervertebral disc. Results the follow-up of 89 cases was from 14 months to 37 months, with an average of (25.11 卤6.96) months. All the patients received lumbar MRI reexamination at the last follow-up in 23 patients in the lumbar X-ray Dynesys group. At the last follow-up, the VAS score and ODI index of lumbago and leg pain in both groups were significantly improved compared with those before operation (P0.05). Compared with before operation, the segmental intervertebral space in Dynesys group was preoperatively. The posterior edge height was significantly decreased (P0.05); there was no significant change in the anterior edge height of upper adjacent segments in both groups (P0.05), but the posterior edge height was significantly lost (P0.05); the anterior and posterior edge height and lumbar lordosis angle were not significantly changed in the two groups. In the last follow-up Dynesys group, the flexion and extension ROM (2.90 卤1.72) 掳decreased significantly compared with the preoperative (5.31 卤2.60) 掳(P0.05), but the preoperative ROM was retained at 64.11%. There was no significant difference between the upper and lower adjacent segments and the whole ROM of the lumbar vertebrae. In the PLIF group, the upper adjacent segment ROM increased from (5.64 卤2.79) 掳to (7.76 卤3.15) 掳, there was statistical difference (P 0.05). There was no significant change in the inferior adjacent segment and lumbar whole ROM compared with the preoperative (P0.05). The 23 patients in the dyesys group received MRI reexamination of lumbar vertebrae. The average CDS was improved from 42.74% 卤13.15% to 47.69% 卤14.38% (P0. 004). Conclusion: compared with fusion, dynesys dynamic neutralization system is also an effective method for the treatment of lumbar degenerative diseases. The Dynesys system retains a fixed segment of ROM, and does not cause hyperactivity in adjacent segments. The rehydration of the residual intervertebral disc suggests that it may promote the repair of degenerative intervertebral disc. However, the loss of height of intervertebral space and the compensatory protruding of superior adjacent segment after Dynesys non-fusion surgery are obvious problems, which need to be followed up for a long time.
【学位授予单位】：暨南大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
【参考文献】
相关期刊论文 前2条
1 张越;孙天胜;姚红;;Dynesys system技术以及PLIF技术治疗腰椎间盘突出症隐性失血的临床分析[J];中国矫形外科杂志;2014年05期
2 梁广胜;殷明;刘玉亮;魏强强;周荣平;殷嫦嫦;;Wnt信号通路与椎间盘的发展[J];中国矫形外科杂志;2014年05期
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