椎间盘切除Dynesys动态稳定系统固定治疗腰椎间盘突出症的中长期疗效

Long-term outcomes of Dynesys stabilization in lumbar disc herniation

中文关键词:  腰椎间盘突出症  Dynesys系统  动态内固定  邻近节段退变

英文关键词:Lumbar disc herniation  Dynesys  Dynamic stabilization  Adjacent segment degeneration

中文摘要:

  【摘要】 目的：回顾性分析椎间盘切除+Dynesys动态稳定系统固定治疗腰椎间盘突出症的中长期疗效。方法：2008年7月~2012年7月因腰椎间盘突出症在我院行椎间盘切除+Dynesys动态稳定系统内固定治疗的患者84例，其中61例获得完整随访资料，男38例，女23例；年龄31~58岁（46.3±11.5岁），随访时间60～108个月（74±14个月）。术前、术后3个月和末次随访时采用疼痛视觉模拟评分（visual analogue scale，VAS）和Oswestry功能障碍指数（Oswestry disability index，ODI）评估，同时行影像学评估，包括手术节段及上位相邻节段椎间隙高度、椎间活动度（rang of motion，ROM）、UCLA椎间隙退变分级（University of California at Los Angeles）以及椎间盘退变Pfirrmann分级。结果：术后3个月、末次随访时VAS评分和ODI均较术前明显改善（P<0.05），所有病例均未见椎间盘突出复发。手术节段椎间隙高度术后3个月（12.3±2.3mm）较术前（11.8±1.8mm）增加，末次随访时（10.1±1.7mm）较术前降低（P<0.05）；上位相邻节段各时间点无显著性差异。手术节段椎间ROM在术后3个月及末次随访分别为5.3°±1.8°及3.6°±1.9°，与术前（8.1°±2.8°）比较均显著性降低（P<0.05）；上位相邻节段ROM在术后3个月和末次随访分别10.3°±3.8°和11.4°±3.7°，均较术前（8.5°±3.0°）显著性增加（P<0.05）。末次随访时手术节段UCLA分级与术前比较有统计学差异（P<0.05），12例（19.7%）上位相邻节段发生影像学退变，1例发生症状学退变（adjacent segment degeneration，ASD）。手术节段和上位邻近节段术前与末次随访椎间盘Pfirmman分级均有统计学差异（P<0.05）。2例出现螺钉断裂，未发生螺钉松动等其他并发症。结论：腰椎间盘切除后应用Dynesys动态稳定系统内固定治疗腰椎间盘突出症可获得满意的中长期疗效，能维持手术节段稳定，保留手术节段部分椎间活动度。

英文摘要:

  【Abstract】 Objectives: To retrospectively study the long-term clinical and radiographic outcomes of lumbar discectomy Dynesys stabilization system in lumbar disc herniation. Methods: From July 2008 to July 2012, 84 patients with lumbar disc herniation were treated by the lumbar discectomy with Dynesys system, including 61 cases with complete follow-up data. There were 38 males and 23 females, whose mean age was 46.3±11.5 years old (range, 31-58 years). The mean follow-up was 74±14 months(60-108 months). Clinical outcomes were evaluated by using Oswestry disability index(ODI) and visual analogue scale(VAS). Radiographic evaluation included the disc height and range of motion(ROM) in lumbar neutral, flexion and extension X-ray. The above indicators were evaluated before surgery, at 3 months and the final follow-up. The change of intervertebral disc signal was defined by MRI, and disc degeneration was classified according to the Pfirrmann grade classification. Results: The ODI score and VAS score significantly improved at 3 months and the final follow-up compared with the preoperative scores(P<0.05). No disc herniation recurred in all cases. The disc height of surgical segments increased at 3 months follow-up(12.3±2.3mm) when compared with that before surgery(11.8±1.8mm)(P>0.05) and decreased at the final follow-up(10.1±1.7mm) when compared with that before surgery(P<0.05). The ROM of surgical segments decreased from 8.1°±2.8° to 5.3°±1.8° at 3 months follow-up and to 3.6°±1.9° at the final follow-up(P<0.05). The ROM of the upper segments increased significantly from 8.5°±3.0° to 10.3°±3.8° at 3 months follow-up and to 11.4°±3.7° at the final follow-up(P<0.05). 12 segments were noted as radiographic ASDs(19.7%) at the final follow-up. 1 segment was noted as the symptomatic adjacent segment degeneration. There was significant change of Pfirrmann grade between preoperation and final follow-up in both groups(P<0.05). There were 2 cases of screws broken. No other complication was found, such as screw loosen. Conclusions: Dynesys stabilization system can obtain the satisfactory clinical outcomes. The stability of the surgical segment can be maintained and partially preserve the ROM of diseased segments after intervertebral disc resection for lumbar degenerative disease in long term follow-up.