后路减压Dynesys动态内固定术治疗腰椎退变性疾病的长期疗效

Long-term outcome of posterior decompression and Dynesys stabilization for lumbar degenerative disease

中文关键词:  腰椎退变性疾病  Dynesys动态内固定  长期疗效

英文关键词:Lumbar degenerative disease  Dynesys dynamic stabilization system  Long-term outcome

中文摘要:

  【摘要】 目的：评估后路减压Dynesys动态内固定治疗腰椎退变性疾病的长期临床疗效。方法：收集2008年7月~2013年12月在我院采用后路减压Dynesys动态内固定治疗的腰椎退变性疾病患者的临床资料，其中163例患者获得78~144个月（95.4±15.6个月）随访，男97例，女66例；年龄31~60岁（43.5±11.7岁）。单节段固定117例，双节段固定42例，三节段固定4例。比较患者术前、术后3个月和末次随访时的Oswestry功能障碍指数（Oswestry disability index，ODI）和腰腿痛视觉模拟量表（visual analogue scale，VAS）评分；在术前、术后3个月和末次随访时的腰椎正侧位和前屈后伸位X线片上测量手术节段和上位邻近节段活动度（range of motion, ROM）及椎间高度，评估影像学和症状学邻近节段退变（adjacent segment degeneration，ASD）发生情况以及内固定相关并发症。结果：术后3个月及末次随访时的ODI和VAS评分均较术前显著性改善（P<0.05），末次随访时与术后3个月时比较差异亦有统计学意义（P<0.05）。术前、术后3个月和末次随访时手术节段的ROM分别为7.8°±2.1°、4.6°±1.4°和3.9°±1.5°，手术节段椎间高度分别为12.1±2.9mm、12.8±3.5mm和10.9±2.8mm，上位邻近节段ROM分别为8.3°±1.9°、9.2°±2.7°和10.2°±2.8°，术后3个月及末次随访时与术前比较、末次随访时和术后3个月比较均有统计学差异（P<0.05）；上位邻近节段椎间高度分别为12.7±3.1mm、12.6±3.2mm和12.1±2.8mm，差异均无统计学意义（P>0.05）。末次随访时32例（19.6%）患者手术节段ROM小于4°（临床融合组），131例（80.4%）大于4°（非融合组），两组患者术前、术后3个月和末次随访时的VAS评分和ODI均无统计学意义（P>0.05）。末次随访时30例（18.4%）患者出现影像学ASD；2例（1.2%）患者出现症状学ASD，其中1例行翻修手术，另1例行保守治疗。1例患者术后2个月出现术区深部感染，抗感染治疗后痊愈；6例患者在术后5年随访时出现单侧螺钉松动，均未行手术治疗。2例患者出现椎弓根螺钉断裂，无不适症状未给予翻修手术。所有患者均无手术节段症状复发。结论：后路减压Dynesys动态内固定治疗腰椎退变性疾病可获得良好的长期临床疗效，并能保留手术节段部分活动度。

英文摘要:

  【Abstruact】 Objectives: To evaluate the long-term clinical and radiographic outcomes of posterior decompression and Dynesys stabilization in the treatment of lumbar degenerative disease. Methods: The clinical data of 163 patients underwent posterior decompression and Dynesys stabilization owing to lumbar degenerative disease were collected from July 2008 to Dec 2013 in our hospital. They were followed up for 78 to 144 months(95.4±15.6 months). There were 97 males and 66 females, aged from 31 to 60 years(43.5±11.7 years). There were 117 cases of single-segment fixation, 42 cases of double-segment fixation and 4 cases of three- segment fixation. The Oswestry disability index(ODI) and visual analogue scale(VAS) scores were compared before operation, 3 months after operation and at the final follow-up; the range of motion(ROM) of the operated segment and the upper adjacent segment were measured on the anteroposterior and lateral position and flexion and extension position X-ray films at preoperation, 3 months after operation and at the final follow-up. The occurrence of adjacent segment degeneration(ASD) and fixation related complications were evaluated. Results: The ODI and VAS scores at 3 months after operation and at the final follow-up were significantly improved compared with those before operation(P<0.05), the difference between the final follow-up and 3 months after operation was also statistically significant(P<0.05). The ROMs of the operated segments were 7.8°±2.1°, 4.6°±1.4° and 3.9°±1.5° at preoperation, 3 months after the operation and the final follow-up, respectively; the disc heights of the operated segments were 12.1±2.9mm, 12.8±3.5mm and 10.9±2.8mm, respectively; the ROM of upper adjacent segments were 8.3°±1.9°, 9.2°±2.7° and 10.2°±2.8°, respectively, the differences were all statistically significant between the values at 3 months after the operation and the preoperation value, the values at the final follow-up and the preoperation, as well as between the value at the final follow-up and the 3 months after the operation(P<0.05). Disc heights of upper adjacent segments were 12.7±3.1mm, 12.6±3.2mm and 12.1±2.8mm, respectively, with no statistical significance(P>0.05). At the final follow-up, 32 patients(19.6%) had ROM less than 4 degrees(clinical fusion group) and 131 patients(80.4%) had ROM more than 4 degrees(non-fusion group). The VAS score and ODI of the two groups were not statistically significant(P>0.05). At the final follow-up, 30 patients(18.4%) developed radiographic ASD, and 2 patients(1.2%) developed symptomatic ASD(one of whom had undergone revision surgery and the other conservative treatment). One patient developed deep infection at 2 months after operation and recovered after anti-infection treatment. Unilateral screw loosening occurred in 6 patients at the 5-year follow-up, and no surgical treatment was performed. Two patients with pedicle screw fracture did not undergo revision surgery due to lack of discomfort. There was no recurrence of surgical segmental protrusion in all patients. Conclusions: Dynesys dynamic system combined with posterior decompression in the treatment of degenerative lumbar spine diseases can achieve good long-term clinical outcome, and can preserve partial ROM of the operated segment.