髓核摘除Dynesys动态内固定系统固定治疗青壮年单节段腰椎间盘突出症的中长期疗效分析

Analysis of mid- and long-term outcomes of discectomy and Dynesys dynamic stabilization system fixation in the treatment of single level lumbar disc herniation in young adults

中文关键词:  腰椎间盘突出症  Dynesys动态内固定系统  青壮年  髓核摘除术

英文关键词:Lumbar disc herniation  Dynesys dynamic stabilization system  Young adults  Discectomy

中文摘要:

  【摘要】 目的：观察髓核摘除Dynesys动态内固定系统固定治疗青壮年单节段腰椎间盘突出症（lumbar disc heniation，LDH）的中长期疗效。方法：回顾性分析2010年12月～2014年8月于我院骨科手术治疗且资料完整的62例青壮年单节段LDH病患者的临床资料，其中31例采用髓核摘除Dynesys动态内固定系统固定术治疗（Dynesys组），31例采用单纯髓核摘除术治疗（对照组），两组患者的年龄、性别比、体重指数、病程、合并基础病、吸烟史、手术节段等基线数据无显著性差异。收集两组患者手术相关资料及并发症，比较两组术前及末次随访时的疼痛视觉模拟评分（visual analogue scale，VAS）、Oswestry功能障碍指数（Oswestry disability index，ODI）、手术节段和近端邻近节段的椎间盘高度（disc height，DH）、椎间活动度（range of motion，ROM）和椎间盘改良Pfirrmann分级。结果：对照组手术时间和术后住院时间更短、术中出血更少（P<0.05）。Dynesys组3例、对照组1例术中发现硬膜撕裂，予以仔细缝合修补，术后均未发生脑脊液漏；Dynesys组和对照组各有1例患者住院期间因发热使用抗生素治疗，均排除手术部位感染。对照组1例患者术后1个月因切口渗液、愈合不良再入院行清创术。Dynesys组随访72～109个月（91.8±11.1个月）；对照组随访72～116个月（93.7±12.7个月）。末次随访时两组患者腰痛和腿痛VAS评分、ODI均较术前显著性改善（P<0.05），两组同时间点比较无显著性差异（P>0.05）；两组手术节段DH均较术前显著性下降（P<0.05），对照组下降比Dynesys组更显著（P<0.05）；两组近端邻近节段DH较术前均无显著性变化。Dynesys组手术节段ROM在末次随访时得到部分保留（2.7°±2.1°），但较术前显著性降低（P<0.05）；近端邻近节段ROM均较术前显著性增加（P<0.05），但与对照组比较无显著性差异。末次随访时两组手术节段和近端邻近节段的椎间盘改良Pfirrmann分级均较术前进展（P<0.05），对照组手术节段退变进展较Dynesys组更明显（P<0.05）。随访期间Dynesys组所有患者手术节段椎间盘突出均无复发，均未发现内固定断裂及松动并发症，无再手术病例，5例手术节段术前合并不稳患者均采用Dynesys动态固定系统固定，术后未再发节段不稳定；对照组3例患者因椎间盘突出复发且保守治疗无效行椎间融合术，1例患者因术后再发腰痛伴手术节段不稳，行椎间融合术。两组患者均未出现症状性邻近节段退变，总体并发症发生率无显著性差异（P>0.05）。结论：髓核摘除Dynesys动态固定系统固定治疗青壮年单节段腰椎间盘突出症安全有效，可减少复发并保留手术节段一定的活动度。

英文摘要:

  【Abstract】 Objectives: To observe the mid- and long-term outcomes of discectomy and Dynesys dynamic stabilization system fixation in the treatment of single level lumbar disc herniation(LDH) in young adults. Methods: A retrospective analysis was performed on 62 young adult patients with single level LDH who underwent orthopedic surgery in the Department of Orthopaedics in our hospital between December 2010 and August 2014 and with complete data. Among the patients, 31 cases were treated with discectomy and Dynesys dynamic stabilization system fixation(Dynesys group), and the rest 31 were treated with discectomy alone(control group). There were no significant differences in baseline data between the two groups such as age, gender ratio, body mass index(BMI), duration of disease, comorbidities, smoking history, and surgical segments. Surgical-related data and complications were collected for both groups of patients. The visual analogue scale(VAS), Oswestry disability index(ODI), and disc height(DH), range of motion(ROM) and modified Pfirrmann grade of the surgical and proximal adjacent segment were compared between the two groups before surgery and at the final follow-up. Results: The control group had shorter operative time and postoperative hospital stay, and less intraoperative blood loss(P<0.05). Three cases in the Dynesys group and 1 case in the control group were found to have dural tears during operation, which were all carefully sutured and repaired, and no cerebrospinal fluid leakage occurred after surgery; One patient in each group had fever during hospitalization, who were both treated with antibiotics and ruled out of surgical site infection. One patient in the control group was re-admitted for debridement due to incision exudation and poor healing one month after surgery. The follow-up time was 72-109 months(91.8±11.1 months) in the Dynesys group and 72-116 months(93.7±12.7 months) in the control group. The VAS scores of low back pain and leg pain and ODI in both groups were significantly improved at the final follow-up compared with those before surgery(P<0.05), and there was no significant difference between the two groups at the same time point(P>0.05). At final follow-up, the DH of the surgical segments in both groups was significantly lower than that before surgery(P<0.05), and the loss in the control group was more significant than that in the Dynesys group(P<0.05); There was no significant change in DH in the proximal adjacent segments in both groups compared with that before surgery. In the Dynesys group, the ROM of the surgical segment was partially preserved(2.7°±2.1°) at the final follow-up, but it was significantly lower than that before surgery(P<0.05); The ROM of the proximal adjacent segments was significantly increased compared with that before surgery(P<0.05), but there was no significant difference compared with the control group. At the final follow-up, the modified Pfirrmann grades of the surgical segments and proximal adjacent segments in both groups had progressed compared with those before surgery(P<0.05). The progression of degeneration of the surgical segments in the control group was more significant than that in the Dynesys group(P<0.05). During the follow-up period, in the Dynesys group, there was no recurrence of disc herniation in all the patients at the surgical segment, nor breakage or loosening of internal fixation or reoperation; Five cases with preoperative segmental instability were all treated with Dynesys dynamic stabilization system fixation, and no segmental instability occurred postoperatively. In the control group, three patients underwent interbody fusion after ineffective conservative treatment due to recurrence of disc herniation, and one patient received interbody fusion due to postoperative low back pain and instability of the surgical segment. There was no symptomatic adjacent segmental degeneration in both groups and no significant difference in the overall complication rate between the two groups(P>0.05). Conclusions: Discectomy combined with Dynesys dynamic fixation is safe and effective for the treatment of single level LDH in young adults, which can reduce LDH recurrence and retain a certain range of motion of the surgical segment.