非融合技术是治疗腰椎退变疾病的一种选择

Non-fusion technique is a surgery of choice for degenerative lumbar spine disease

中文关键词:  腰椎  退变性疾病  动态内固定  Dynesys系统  相邻节段退变

英文关键词:Lumbar vertebrae  Degenerative disease  Dynamic stabilization  Dynesys  Adjacent segment degeneration.

中文摘要:

  【摘要】 目的：评估后路减压结合Dynesys动态内固定治疗腰椎退变性疾病的中期疗效。方法：回顾分析2008年7月~2010年5月采用后路减压结合Dynesys动态内固定治疗的腰椎退变性疾病患者59例，其中腰椎管狭窄症38例，腰椎间盘突出症21例。记录患者术前、术后3个月及末次随访时Oswestry功能障碍指数（ODI）和疼痛视觉模拟量表（VAS）评分，测量术前、术后3个月及末次随访时手术节段活动度（ROM）、椎间高度及上位相邻节段ROM，评估上位相邻节段影像学和症状学退变的发生情况。结果：55例患者获得完整随访，随访48~70个月，平均54个月。术后3个月和末次随访时的ODI分别为（24.1±5.7）%和（15.9±6.3）%，均较术前的（56.3±16.4）%明显改善（P<0.05）。术后3个月和末次随访时的VAS评分分别为2.9±1.5和1.4±0.5，均较术前的6.7±2.7明显改善（P<0.05）。手术节段ROM由术前的（7.6±2.5）°保留至术后3个月的（4.5±2.8）°以及末次随访时的（4.9±2.3）°（P<0.05）。手术节段椎间高度在术后3个月为13.4±2.6mm，较术前12.3±2.7mm明显升高（P<0.05）；末次随访时为12.1±3.2mm，与术前差异无统计学意义（P>0.05）。上位相邻节段ROM由术前的（8.1±3.0）°增加至术后3个月的（9.3±3.2）°，至末次随访时达到（10.0±2.9）°（P<0.05）。末次随访时，7例（12.7%）患者出现上位相邻节段影像学退变，1例患者出现上位相邻节段症状学退变而接受二次Dynesys内固定手术。结论：后路减压结合Dynesys动态内固定能够获得良好的中期临床疗效。在中期随访时，Dynesys动态内固定能够保留手术节段部分活动度，存在一定程度的相邻节段退变。

英文摘要:

  【Abstract】 Objectives: To evaluate the midterm clinical and radiographic outcomes of posterior decompression and Dynesys stabilization in the treatment of lumbar degenerative disease. Methods: From July 2008 to May 2010, 59 patients suffering from lumbar degenerative disease underwent lumbar spine stabilization with Dynesys were retrospectively analyzed. Clinical outcomes were evaluated by using Oswestry disability index(ODI) and visual analogue scale(VAS). Radiographic evaluations included the mean range of motion(ROM) and the disc height of stabilized segments and the ROM of upper adjacent segments under lumbar neutral, flexion and extension X-ray. The occurrence of radiographic and symptoms due to adjacent segment degeneration(ASD) was evaluated. Results: 55 patients completed the follow-up more than four years. The mean follow-up was 54 months(48-70 months). The ODI score significantly improved at 3 months[(24.1±5.7)%] and the final follow-up[(15.9±6.3)%] compared with the preoperative score[(56.3±16.4)%, P<0.05]. The VAS score significantly decreased at 3 months(2.9±1.5) and the final follow-up(1.4±0.5) compared with the preoperative score(6.7±2.7, P<0.05). The ROM of surgical segments decreased from (7.6±2.5)° to (4.5±2.8)° at 3 months postoperatively and to (4.9±2.3)° at the final follow-up(P<0.05). The disc height of surgical segments increased significantly at 3 months postoperatively(13.4±2.6mm) compared with the preoperative(12.3±2.7mm)(P<0.05), and finally decreased(12.1±3.2mm) to the preoperative value(P>0.05). The ROM of the upper segment increased significantly from (8.1±3.0)° to (9.3±3.2)° at 3 months postoperatively and to (10.0±2.9)° at the final follow-up(P<0.05). 7 cases were noted with radiographic ASDs(12.7%) at the final follow-up. 1 patient received a revision operation due to the symptomatic ASD. Conclusions: Posterior decompression and Dynesys placement can improve the clinical outcomes for lumbar degenerative disease at midterm follow-up. Dynesys partially preserves the ROM of diseased segments, but the incidence of ASD should be considered at midterm follow- up.