腰椎后路非融合技术能够减少邻近节段退变吗

Comparisons of Dynesys stabilization and posterior lumbar interbody fusion for L4/5 single-segment lumbar degenerative disease

中文关键词:  腰椎  Dynesys系统  动态固定  后路椎间融合  椎弓根螺钉  邻近节段退变

英文关键词:Lumbar spine  Dynesys system  Dynamic fixation  Posterior lumbar interbody fusion  Pedicle screw  Adjacent segment degeneration

中文摘要:

  摘要】 目的：评估Dynesys内固定或融合术治疗L4/5单节段腰椎退变疾病的临床疗效。方法：回顾分析2008年7月～2012年7月收治的L4/5单节段退变疾病患者76例，其中采用Dynesys动态固定35例（Dynesys组），融合术41例（融合组），随访时间均大于2年。评价指标采用Oswestry功能障碍指数（ODI），疼痛视觉模拟评分（VAS），手术节段及上端、下端邻近节段椎间高度及活动度（ROM），邻近节段椎间盘Pfirmman分级，并应用UCLA系统来评价邻近节段退变情况。结果：两组末次随访时的ODI及VAS评分均较术前明显改善（P<0.05），两组间比较差异无统计学意义（P>0.05）。两组手术节段椎间高度术前无显著性差异，末次随访时Dynesys组较术前无明显变化，融合组明显增高（P<0.05），两组间差异有统计学意义（P<0.05）。邻近节段椎间高度术前及末次随访时两组间比较差异均无显著性（P>0.05）。术前上端邻近节段ROM在Dynesys组为8.3°±2.1°，融合组为8.4°±1.5°，末次随访时Dynesys组为10.2°±2.2°，融合组为12.9°±2.1°，均较术前增加（P<0.05），组间差异有统计学意义（P<0.05）。术前下端邻近节段ROM两组间差异无显著性，末次随访时融合组较术前明显增加（P<0.05），但组间差异无显著性（P＞0.05）。两组术前Pfirrmann分级无统计学差异，末次随访时Pfirrmann分级变化组内有统计学差异（P<0.05），但组间仅上端邻近节段差异有统计学意义（P＜0.05）。根据UCLA系统评分标准，Dynesys组8个节段出现影像学邻近节段退变，融合术组为22个节段，两组间差异有统计学意义（P<0.05）。仅融合术组有1例患者出现症状学邻近节段退变，行二次手术治疗。结论：Dynesys动态固定或融合术治疗单节段腰椎退变疾病均可取得满意临床疗效，前者在预防邻近节段退变方面更有优势。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical and radiographic results between Dynesys and posterior lumbar interbody fusion(PLIF) in the treatment of lumbar degenerative disease. Methods: 76 cases of lumbar degenerative disease were treated with either Dynesys or PLIF between July 2008 and July 2012, 35 patients underwent Dynesys procedure and 41 underwent PLIF. The follow-up period was more than 24 months. The clinical outcome was evaluated by visual analogue scale(VAS) and Oswestry disability index (ODI). Range of motion(ROM) and the intervertebral height of lumbar segments were measured by X-rays. The change of intervertebral disc signal was defined by MRI, and disc degeneration was classified according to the Pfirrmann grade classification. Results: The ODI and VAS score significantly improved in both groups at the final follow-up(P<0.05), but the difference between two groups was not significant(P>0.05). The ROM of proximal adjacent segments in both groups(Dynesys group, 8.3°±2.1°; PLIF group, 8.4°±1.5°) increased significantly(P<0.05) at the final follow-up(Dynesys group, 10.2°±2.2°; PLIF group, 12.9°±2.1°). The changes were significant between two groups(P<0.05). The ROM of distal adjacent segments in both groups increased significantly(P<0.05) at the final follow-up, but there was no significant between two groups(P＞0.05). There were significant changes of Pfirrmann grade between the preoperation and final follow-up in both groups(P<0.05). According to University of California at Los Angeles Grading Scale, there were 8 cases in the Dynesys group and 22 in the PLIF group with radiological adjacent segment degeneration, the difference was significant between two groups(P<0.05). Only 1 case in PLIF group had symptomatic adjacent segment degeneration, and received a second operation. Conclusions: Both Dynesys and PLIF are reliable for lumbar degenerative disease. Dynesys stabilization has less influence on the ROM of cranial adjacent segments, and therefore less risks in developing ASD.