| 刘广武,王子滔,方忠,等.Dynesys系统治疗腰椎退变性疾病的早期疗效.骨科,2017,8(6): 417-422. |
| Dynesys系统治疗腰椎退变性疾病的早期疗效 |
| Short-term outcome of Dynesys device for the treatment of degenerative lumbar disease |
| 投稿时间：2017-04-09 |
| DOI：10.3969/j.issn.1674-8573.2017.06.001 |
| 中文关键词: 腰椎 内固定器 治疗结果 并发症事件 活动度 |
| 英文关键词: Lumbar vertebrae Internal fixators Treatment outcome Complications Range of motion |
| 基金项目:国家自然科学基金（81472133）；湖北省技术创新与专项重大项目（2016ACA149） |
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| 中文摘要: |
| 目的 探讨采用Dynesys系统治疗腰椎退变性疾病的早期临床疗效，并观察邻近节段的退变趋势。方法 回顾性分析2013年1月至2013年12月于我院治疗的21例腰椎退变性疾病病人的病例资料，其中男16例（76.2%），女5例（23.8%）；年龄为24~60岁，平均（42.1±9.4）岁。在严格控制适应证及熟练掌握标准化手术操作流程的基础上，对腰椎退变性疾病病人采用腰椎后路减压+Dynesys植入治疗。分别于术前和术后3、6、12个月及末次随访，对病人进行腰腿部疼痛视觉模拟量表（visual analogue scale, VAS）、腰部Oswestry功能障碍指数（Oswestry disability index, ODI）、日本骨科协会（Japanese Orthopaedic Association, JOA）腰痛治疗评估量表评分和SF-36（short form health survey-36）生活质量问卷调查评分，并统计各种并发症的发生率。对比术前及术后末次随访时腰椎活动度（range of motion, ROM）及改良Pfirrmann椎间盘退变MRI分级（改良Pfirrmann分级）的改变。结果 21例病人均获得随访，随访时间为12~24个月，平均（17.4±3.5）个月。术后各时间点及末次随访的腰痛及腿痛VAS评分、ODI均较术前明显下降，JOA评分及SF-36生活质量评分均较术前明显增加，差异均有统计学意义（均P＜0.05）。至末次随访，发生并发症2例（9.5%）：1例螺钉松动但无临床症状，建议病人定期随诊；1例切口下积液，经定期换药3周，切口愈合良好。末次随访时手术节段上一相邻节段ROM及改良Pfirrmann分级均较术前增加（均P＜0.05）。结论 Dynesys系统治疗腰椎退变性疾病可获得良好的早期临床疗效，短期随访显示手术节段上一相邻节段的退变趋势更为明显。 |
| 英文摘要: |
| Objective To analyze the short-term outcomes of dynamic stabilization in the treatment of degenerative lumbar disease and investigate the effect of dynamic stabilization on the progression of the degeneration in the adjacent segments. Methods Twenty-one patients who underwent Dynesys procedure between January 2013 and December 2013 were included in this study. The mean duration of follow-up was 17.4±3.5 months (range, 12-24 months). Preoperative, postoperative (at 3rd, 6th, and 12th month) and the last follow-up questionnaires were obtained to evaluate clinical outcomes. The questionnaires included visual analogue scale (VAS) scores for back pain and leg pain, Oswestry disability index (ODI), Japanese Orthopaedic Association (JOA) scores for low back pain and short form health survey-36 (SF-36). Radiographs, computed tomography (CT), and magnetic resonance imaging (MRI) were done to measure the range of motion (ROM) of the intervertebral space, and modified Pfirrmann grading. Results VAS scores for back pain and leg pain, ODI and JOA scores for low back pain, and SF-36 questionnaire received a statistically significant improvement at the last follow-up as compared with preoperative status. The incidence of complications was 9.5% (2 cases). In 1 case, radiological signs of screw loosening were observed, but without symptoms, and 1 case of subcutaneous hydrops recovered after wound care for 3 weeks. Radiographically, the modified Pfirrmann grading and the ROM at the upper segments increased significantly (P＜0.05). Conclusion Dynesys is a safe and effective procedure in the treatment of symptomatic degenerative lumbar disease in short-term follow-up. The increase of the ROM and the modified Pfirrmann grading at the upper segments could be due to the Dynesys or the progression of physiological degeneration. |
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