Dynesys动态固定系统经Wiltse入路治疗盘源性腰痛的疗效评价
|
摘要
目的回顾分析dynesys动态固定系统经Wiltse入路治疗盘源性腰痛的临床疗效。方法回顾性分析2014年1月至2017年1月经Wiltse入路Dynesys治疗的20例盘源性腰痛患者的临床资料,其中男性11例,女性9例;平均年龄33.8岁(25-46岁)。记录手术前和手术后随访期间的视觉模拟量表(VAS)评分,Oswestry残疾指数(ODI),评价患者术前与术后疼痛情况、功能状态。同时进行影像学评估,包括手术节段椎间隙高度、椎间活动度(rang of motion,ROM)以及椎间盘退变评分Pfirrmann分级变化情况。结果 20例(100%)均获得随访,随访时间12～24个月,平均18个月。随访期间患者无螺钉松动、断裂或再次手术的情况。术后6个月、末次随访时,患者腰腿痛VAS评分和ODI指数较手术前明显改善,其中VAS由术前的(7.1±1.2)减少到术后末次随访的(1.6±0.6)、ODI评分由术前的(67.64±9.30)减少到术后末次随访的(17.65±3.07),(P<0.05)。患者术前椎间高度,术后6个月手术节段椎间高度以及末次随访时的椎间高度之间相比均无统计学差异(P>0.05),仍能维持术前的椎间高度;与术前稳定节段的平均ROM相比,术后6个月以及最后随访各稳定节段ROM均明显下降(P<0.05),但仍保留固定节段的部分ROM。术后的随访中14例患者接受MRI检查,采用Pfirrmann分级评分进行椎间盘退变的评估,其中6例(42.8%)患者手术节段椎间盘信号强度增加,8例(57.1%)椎间盘信号没有明显的改变,但并未出现退变加重的现象。结论 Dynesys经Wiltse入路治疗盘源性腰痛,手术创伤小、临床疗效确切,有效缓解疼痛、维持椎间隙的高度、ROM,减少ASD的发生。对于盘源性腰痛患者的椎间盘给予保留,有利于恢复腰椎正常的生物力学特性,维持腰椎的正常功能,同时具有延缓退变发展甚至促进退变椎间盘再水化的作用。
Objective To explore the clinical efficacy of Dynesys system for treatment of discogenic low back pain(DLBP).Methods The clinical data( from January 2014 to January 2017) of 20 patients with DLBP disease,who were treated with Dynesyssystem,were retrospectively reviewed. A total of 20 cases were followed, including 11 males and 9 females and the mean age was 33.8 years(25-46 years). The visual analog scale( VAS) score and Oswestry Disability Index( ODI) score were recorded preoperatively andpostoperatively to evaluate pain and functional status. At the same time, the heights of anterior and posterior intervertebral spaces,andflexion-extension range of motion(ROM) were measured using radiography of the lumbar spine,and intervertebral disc degenerationscore Pfirrmann grading changes was calculated using lumbar magnetic resonance imaging(MRI). Results All 20 patients(100%) werefollowed up for 12 to 24 months with an average of 18 months. There were no loosening, rupture, or reoperation of the patient duringfollow-up. At 6 months and at the last follow-up, the VAS score and ODI index of the patients with low back pain were significantlyimproved compared with those before surgery. The VAS was reduced from preoperative(7.1±1.2) to the last follow-up(1.6±0.6).The ODI score was reduced from preoperative(67.64±9.30) to the last follow-up(17.65±3.07),(P<0.05). There was no significantdifference in preoperative intervertebral height, intervertebral height at 6 months postoperatively, and intervertebral height at the lastfollow-up(P>0.05), still maintaining preoperative intervertebral height. Compared with the mean ROM of the preoperative stablesegment, the ROM of the stable segment was significantly decreased at 6 months and at the last follow-up(P<0.05), but some ROMof the fixed segment remained. During the follow-up, 14 patients underwent MRI. The Pfirrmann grading score was used to evaluatethe disc degeneration. Among them, 6 patients(42.8%) had increased intervertebral disc signal intensity, and 8 patients(57.1%) had noobvious disc signal. Change, but there is no phenomenon of degeneration and aggravation. Conclusion Dynesys system for treatmentof discogenic low back pain(DLBP) can obtain the satisfactory clinical outcomes. It could be maintained and partially preserve theROM and reduce the occurrence of ASD. Retention of intervertebral discs in patients with discogenic low back pain is conducive torestoring the normal biomechanical properties of the lumbar spine, maintaining the normal function of the lumbar spine, and delayingthe development of degeneration and even promoting the rehydration of the intervertebral disc.
Objective To explore the clinical efficacy of Dynesys system for treatment of discogenic low back pain(DLBP).Methods The clinical data( from January 2014 to January 2017) of 20 patients with DLBP disease,who were treated with Dynesyssystem,were retrospectively reviewed. A total of 20 cases were followed, including 11 males and 9 females and the mean age was 33.8 years(25-46 years). The visual analog scale( VAS) score and Oswestry Disability Index( ODI) score were recorded preoperatively andpostoperatively to evaluate pain and functional status. At the same time, the heights of anterior and posterior intervertebral spaces,andflexion-extension range of motion(ROM) were measured using radiography of the lumbar spine,and intervertebral disc degenerationscore Pfirrmann grading changes was calculated using lumbar magnetic resonance imaging(MRI). Results All 20 patients(100%) werefollowed up for 12 to 24 months with an average of 18 months. There were no loosening, rupture, or reoperation of the patient duringfollow-up. At 6 months and at the last follow-up, the VAS score and ODI index of the patients with low back pain were significantlyimproved compared with those before surgery. The VAS was reduced from preoperative(7.1±1.2) to the last follow-up(1.6±0.6).The ODI score was reduced from preoperative(67.64±9.30) to the last follow-up(17.65±3.07),(P<0.05). There was no significantdifference in preoperative intervertebral height, intervertebral height at 6 months postoperatively, and intervertebral height at the lastfollow-up(P>0.05), still maintaining preoperative intervertebral height. Compared with the mean ROM of the preoperative stablesegment, the ROM of the stable segment was significantly decreased at 6 months and at the last follow-up(P<0.05), but some ROMof the fixed segment remained. During the follow-up, 14 patients underwent MRI. The Pfirrmann grading score was used to evaluatethe disc degeneration. Among them, 6 patients(42.8%) had increased intervertebral disc signal intensity, and 8 patients(57.1%) had noobvious disc signal. Change, but there is no phenomenon of degeneration and aggravation. Conclusion Dynesys system for treatmentof discogenic low back pain(DLBP) can obtain the satisfactory clinical outcomes. It could be maintained and partially preserve theROM and reduce the occurrence of ASD. Retention of intervertebral discs in patients with discogenic low back pain is conducive torestoring the normal biomechanical properties of the lumbar spine, maintaining the normal function of the lumbar spine, and delayingthe development of degeneration and even promoting the rehydration of the intervertebral disc.
引文
[1]Manchikanti L,Singh V,Falco FJ,et al.Epidemiology oflow back pain in adults[J].Neuromodulation,2014,17(Suppl2):3-10.
[2]黄乔东,魏迨桂,赵国栋,等.椎间盘内电热疗法治疗盘源性腰痛临床观察[J].南方医科大学学报,2010,30(10):2406-2407.
[3]彭宝淦,庞晓东,李端明,等.椎间盘源性腰痛的自然病史和预后[J].中华医学杂志,2009,89(31):2171-2174.
[4]Kallewaard JW,Terheggen MA,Groen GJ,et al.Discogenic low back pain[J].Pain Pract,2010,10(6):60-579.
[5]刘伟,宋滇文,贾连顺.椎间盘源性腰痛的病理生理学机制[J].中国矫形外科杂志,2009,17(05):364-366.
[6]胡永胜,阿曼,周刚,等.椎间盘源性腰痛的治疗方法选择及疗效评价[J].中国矫形外科杂志,2013,21(15):1497-1501.
[7]曹春风,王群波,卢旻鹏,等.椎间盘源性腰痛的诊断和治疗进展[J].颈腰痛杂志,2016,37(02):143-146.
[8]韩岳,夏群,胡永成,等.椎间盘造影压力及形态学变化对椎间盘源性腰痛的诊断意义[J].中华骨科杂志,2012,(4):317-322.
[9]Wang H,Li Z,Zhang C,et al.Correlation between high-intensity zone on MRI and discography in patients with low back pain[J].Medicine(Baltimore),2017,96(30):e7222.
[10]林友禧,沈建雄.椎间盘源性腰痛诊治的研究进展[J].中华骨与关节外科杂志,2015,(6):534-537.
[11]Chien CY,Kuo YJ,Lin SC,et al.Kinematic and mechanical comparisons of lumbar hybrid fixation using Dynesys and Cosmic systems[J].Spine,2014,39:E878-84.
[12]王小刚,强晓军,杨彬,等.Dynesys动态固定系统治疗腰椎间盘突出症的临床疗效[J].中国矫形外科杂志,2017,25(11):1045-1047.
[13]张阳,李放,单建林,等.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[J].中国脊柱脊髓杂志,2014,24(10):886-891.
[14]吴恙,李兴中,倪东亮,等.Dynesys动态内固定系统治疗腰椎退行性变的临床疗效观察[J].中国矫形外科杂志,2016,24(01):78-81.
[15]王飞,陈智,魏显招,等.Dynesys动态固定系统在临床应用中的新进展[J].中国矫形外科杂志,2013,21(1):54-57.
[16]Lee CH,Jahng TA,Hyun SJ,et al.Dynamic stabilization using the Dynesys system versus posterior lumbar interbody fusion for the treatment of degenerative lumbar spinal disease:a clinical and radiological outcomesbased meta-analysis[J].Neurosurg Focus,2016,40:E7.
[17]Fay LY,Wu JC,Tsai TY,et al.Intervertebral disc rehydration after lumbar dynamic stabilization:magnetic resonance image evaluation with a mean followup of four years[J].Adv Orthop,2013,2013:437570.
[18]刘园桐,镇万新,杨大志,等.Dynesys非融合术后腰椎节段放射学改变及椎间盘再水化[J].中国矫形外科杂志,2015,23(13):1173-1178.
[2]黄乔东,魏迨桂,赵国栋,等.椎间盘内电热疗法治疗盘源性腰痛临床观察[J].南方医科大学学报,2010,30(10):2406-2407.
[3]彭宝淦,庞晓东,李端明,等.椎间盘源性腰痛的自然病史和预后[J].中华医学杂志,2009,89(31):2171-2174.
[4]Kallewaard JW,Terheggen MA,Groen GJ,et al.Discogenic low back pain[J].Pain Pract,2010,10(6):60-579.
[5]刘伟,宋滇文,贾连顺.椎间盘源性腰痛的病理生理学机制[J].中国矫形外科杂志,2009,17(05):364-366.
[6]胡永胜,阿曼,周刚,等.椎间盘源性腰痛的治疗方法选择及疗效评价[J].中国矫形外科杂志,2013,21(15):1497-1501.
[7]曹春风,王群波,卢旻鹏,等.椎间盘源性腰痛的诊断和治疗进展[J].颈腰痛杂志,2016,37(02):143-146.
[8]韩岳,夏群,胡永成,等.椎间盘造影压力及形态学变化对椎间盘源性腰痛的诊断意义[J].中华骨科杂志,2012,(4):317-322.
[9]Wang H,Li Z,Zhang C,et al.Correlation between high-intensity zone on MRI and discography in patients with low back pain[J].Medicine(Baltimore),2017,96(30):e7222.
[10]林友禧,沈建雄.椎间盘源性腰痛诊治的研究进展[J].中华骨与关节外科杂志,2015,(6):534-537.
[11]Chien CY,Kuo YJ,Lin SC,et al.Kinematic and mechanical comparisons of lumbar hybrid fixation using Dynesys and Cosmic systems[J].Spine,2014,39:E878-84.
[12]王小刚,强晓军,杨彬,等.Dynesys动态固定系统治疗腰椎间盘突出症的临床疗效[J].中国矫形外科杂志,2017,25(11):1045-1047.
[13]张阳,李放,单建林,等.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[J].中国脊柱脊髓杂志,2014,24(10):886-891.
[14]吴恙,李兴中,倪东亮,等.Dynesys动态内固定系统治疗腰椎退行性变的临床疗效观察[J].中国矫形外科杂志,2016,24(01):78-81.
[15]王飞,陈智,魏显招,等.Dynesys动态固定系统在临床应用中的新进展[J].中国矫形外科杂志,2013,21(1):54-57.
[16]Lee CH,Jahng TA,Hyun SJ,et al.Dynamic stabilization using the Dynesys system versus posterior lumbar interbody fusion for the treatment of degenerative lumbar spinal disease:a clinical and radiological outcomesbased meta-analysis[J].Neurosurg Focus,2016,40:E7.
[17]Fay LY,Wu JC,Tsai TY,et al.Intervertebral disc rehydration after lumbar dynamic stabilization:magnetic resonance image evaluation with a mean followup of four years[J].Adv Orthop,2013,2013:437570.
[18]刘园桐,镇万新,杨大志,等.Dynesys非融合术后腰椎节段放射学改变及椎间盘再水化[J].中国矫形外科杂志,2015,23(13):1173-1178.