椎管减压椎弓根动态稳定系统（Dynesys）治疗腰椎管狭窄症的临床疗效

The analysis of clinical efficacy using dynamic internal fixation（Dynesys） for the treatment of lumbar spinal stenosis

中文关键词:  Dynesys  腰椎  椎管狭窄症

英文关键词:Dynesys  Lumbar vertebrae  Spinal stenosis

中文摘要:

  【摘要】 目的：评估椎管减压椎弓根动态稳定系统（Dynesys）固定治疗腰椎管狭窄症的临床疗效。方法：2008年8月～2009年12月，对24例单节段腰椎管狭窄症患者行椎管减压Dynesys椎弓根动态稳定系统内固定置入术，其中男11例，女13例。年龄35～70岁，平均52.3岁。治疗节段：L4/5 10例，L5/S1 14例。手术采用椎板开窗减压或部分切除，减压后置入Dynesys系统装置。按照Oswestry功能障碍指数评分（Oswestry disability index，ODI）、视觉模拟评分（visual analogue scale，VAS）和日本矫形外科学会（Japanese orthopaedic association，JOA）评分评估临床疗效，同时行影像学观察椎间隙高度、手术节段的活动度，手术及相邻节段椎体的退行性改变。结果：平均随访19.1个月（12～28个月）。ODI评分术前为30.46±10.33分，末次随访时为10.38±3.41分；VAS评分术前为7.79±1.50分，末次随访时为2.79±1.77分；JOA评分术前为9.63±3.57分，末次随访时为24.33±2.10分，最终疗效评价有效率91.67%。L4/5、L5/S1节段术后Cobb角分别为16.69°±1.68°和15.36°±1.85°均较术前减少，腰椎曲度改善。L4/5节段椎体的活动度（ROM）术前、术后6个月、术后1年及末次随访分别为7.53°±2.19°、3.85°±1.25°、3.85°±1.20°和3.84°±1.43°，L5/S1节段的ROM分别为7.20°±2.34°、3.39°±1.30°、3.31°±1.40°和3.36°±1.58°。L4/5腹侧椎间隙高度术前为13.03±1.86mm，末次随访为15.31±1.35mm；背侧椎间隙高度术前为7.49±1.46mm，末次随访时为8.98±1.17mm；L5/S1腹侧椎间隙高度术前为12.19±1.69mm，末次随访时为14.34±1.91mm；背侧椎间隙高度术前为7.41±1.34mm，末次随访时为8.48±1.07mm。无论L4/5或L5/S1，末次随访时其椎间隙高度均较术前显著增加（P＜0.05）。结论：Dynesys作为一种非融合动态稳定系统，在辅助治疗腰椎管狭窄症中保留了腰椎生理曲度和固定节段的活动性，解剖结构的完整性，增加并维持了椎间隙高度，是辅助治疗腰椎管狭窄症的有效方法之一。

英文摘要:

  【Abstract】 Objective：To evaluate the clinical efficacy and the changes of imaging using dynamic internal fixation（Dynesys） for the treatment of lumbar spinal stenosis.Method：24 consecutive patients with lumbar spinal stenosis underwent limited laminectomy and were implanted with Dynesys between August 2008 and December 2009.In these patients，there were 11 men and 13 women，whose mean age was 52.3 years（range，35-70）.Ten patients were fixed at L4/5 level，and fourteen patients at L5/S1 level.Clinical outcomes were evaluated using ODI，VAS and JOA before and after operation.Imaging examinations for intervertebral space，surgical segmental movement and adjacent level changes were obtained.Result：Average follow-up time was 19.1 months（range，12-28 months）.The mean preoperative ODI was 30.46±10.33，and the postoperative ODI was 10.38±3.41.Mean VAS score was reduced from 7.79±1.50 preoperatively to 2.79±1.77 postoperatively.The JOA score was improved remarkably from 9.63±3.57 preoperatively to 24.33±2.10 postoperatively.The proportion of efficiency evaluation was 91.67%.Mean Cobb angle of postoperation was reduced to 16.69°±1.68° and 15.36°±1.85°respectively at L4/5 and L5/S1 level.The range of motion at L4/5 level was 7.53°±2.19° at preoperation，and after operation at 3-month，6-mongth，1-year intervals and final follow-up was 3.85°±1.25°，3.85°±1.20° and 3.84°±1.43° respectively；while at L5/S1 level it was 7.20°±2.34°，3.39°±1.30°，3.31°±1.40° and 3.36°±1.58° respectively.The VH of L4/5 increased from 13.03±1.86mm to 15.31±1.35mm，while the DH increased from 7.49±1.46mm to 8.98±1.17mm.The VH of L5/S1 increased from 12.19±1.69mm to 14.34±1.91mm，and the DH increased from 7.41±1.34mm to 8.48±1.07mm.The heights of the intervertebral space including DH and VH were significantly higher than those before operation（P＜0.05）.Conclusion：Dynesys system as a non-fusion dynamic stabilization system was available to reserve segmental movement and preserve the integrity of anatomical structures，to increase and maintain intervertebral space height.The system appears to be an useful and effective manner for the treatment of lumbar spinal canal stenosis.