腰椎退行性疾病Dynesys非融合内固定治疗的临床疗效
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摘要
背景:腰椎退行性疾病是骨科的研究热点,融合与非融合内固定治疗长期存在争议。目的:探讨腰椎退行性疾病应用Dynesys非融合内固定系统治疗的的中长期临床效果。方法:2008年1月至2016年12月共收治30例腰椎退行性疾病患者,男19例,女11例;年龄为33~58岁,平均(49.7±3.4)岁。术前完善详细的影像学检查包括腰椎正侧位X线片,腰椎动力位X线片,腰椎椎体加间隙平扫+二维重建CT,腰椎MRI及腰椎功能评分,手术方式采用后路相应病灶节段Dynesys非融合椎弓根内固定术。采用腰椎障碍功能指数ODI评分和日本矫形外科协会(JOA)评分标准进行临床疗效评价。对患者术前及末次随访神经功能与自觉症状进行评估并计算改善率,结果进行统计学分析。结果:30例患者全部获得随访,随访时间为12~90个月,平均(61.1±19.3)个月。末次随访时JOA评分优良率为93%(28/30)。ODI评分术后较术前有显著下降,疼痛评分VAS也有显著下降,差异有统计学意义(P<0.05)。随访时患者均未出现椎间隙感染、腰椎失稳及内固定失效等并发症。结论:Dynesys非融合椎弓根内固定术是治疗腰椎退行性疾病的有效方法,能保留腰椎生理性运动功能的作用,改善腰椎失稳的效果确切,与传统的腰椎后路融合手术效果相当,无明显差异。
Background: Lumbar degenerative disease is a research hotspot. Fusion or non-fusion fixation is still in dispute.Objective: To explore medium-and long-term clinical effects of Dynesys non-fusion internal fixation on the lumbar degenerative diseases. Methods: Thirty patients with lumbar degenerative diseases admitted to our hospital between January 2008 and December 2016 were enrolled in this retrospective study. There were 19 males and 11 females with an average age of(49.7±3.4) years(range, 33-58 years). Detailed imageological examination were performed in all the patients before surgery,including lumbar anteroposterior and lateral X-ray, dynamic X-ray, CT scanning+two-dimensional reconstruction and MR.All the patients received Dynesys pedicle screw fixation through posterior approach. Oswestry disability index(ODI) and Japanese Orthopedics Association(JOA) score were used to assess the clinical outcomes. Neurological function and subjective symptoms were recorded before surgery and at the final follow-up. The improvement rate was calculated. Results: The mean duration of follow-up was(61.1±19.3) months(range, 12-90 months) in the 30 patients. The excellent and good rate of JOA score was 93%(28/30) at the final follow-up. Postoperative ODI and VAS scores were significantly lower than preoperative ones(P<0.05). No lumbar intervertebral instability or infection, fixation failure occurred during follow-up. Conclusions: Dynesys fixation is an effective method for lumbar degenerative diseases. It can maintain physiological motor function of the lumbar vertebrae and significantly improve intervertebral instability, and has similar clinical outcome in ameliorating lumbar and less pain to traditional posterior approach fusion.
Background: Lumbar degenerative disease is a research hotspot. Fusion or non-fusion fixation is still in dispute.Objective: To explore medium-and long-term clinical effects of Dynesys non-fusion internal fixation on the lumbar degenerative diseases. Methods: Thirty patients with lumbar degenerative diseases admitted to our hospital between January 2008 and December 2016 were enrolled in this retrospective study. There were 19 males and 11 females with an average age of(49.7±3.4) years(range, 33-58 years). Detailed imageological examination were performed in all the patients before surgery,including lumbar anteroposterior and lateral X-ray, dynamic X-ray, CT scanning+two-dimensional reconstruction and MR.All the patients received Dynesys pedicle screw fixation through posterior approach. Oswestry disability index(ODI) and Japanese Orthopedics Association(JOA) score were used to assess the clinical outcomes. Neurological function and subjective symptoms were recorded before surgery and at the final follow-up. The improvement rate was calculated. Results: The mean duration of follow-up was(61.1±19.3) months(range, 12-90 months) in the 30 patients. The excellent and good rate of JOA score was 93%(28/30) at the final follow-up. Postoperative ODI and VAS scores were significantly lower than preoperative ones(P<0.05). No lumbar intervertebral instability or infection, fixation failure occurred during follow-up. Conclusions: Dynesys fixation is an effective method for lumbar degenerative diseases. It can maintain physiological motor function of the lumbar vertebrae and significantly improve intervertebral instability, and has similar clinical outcome in ameliorating lumbar and less pain to traditional posterior approach fusion.
引文
[1]王利元,张承昱,罗磊,等.Dynesysy动态固定系统用于腰椎多阶段退行性疾病的2年随访临床疗效观察.第三军医大学学报,2017,39(11):1165-1170.
[2]叶玉国,伍骥,郑超,等.L3-5节段退变性疾病融合与非融合术式的选择.安徽医科大学学报,2015,50(3):364-367.
[3]Lee JC,Kim Y,Soh JW,et al.Risk factors of adjacent segment disease requiring surgery after lumbar spinal fusion comparison of posterior lumbar interbody fusion and posterolateral fusion.Spine,2014,39(5):339-345.
[4]刘克骏,米明珊,白海明,等.腰椎退行性疾病Dynesys动态固定系统治疗的临床疗效.实用医学杂志,2016,(5)1006-5725.
[5]Liu C,Wang L,Tian JW.Early clinical effects of the Dynesys system plus transfacet decompression through the Wiltse approach for the treatment of lumbar degenerative diseases Med Sci Monit,2014,20:853-859.
[6]呂乔,刘卫华,程微,等.Dynesys动态内固定与融合术治疗腰椎退变疾病的对比研究.河北医学,2015,21(4):603-605.
[7]张增辉,李新春,李明才,等.髓核摘除联合Dynesys系统治疗老年腰椎间盘突出症的疗效观察.浙江医学,2015,37(1):52-55.
[8]Lee SE,Jahng TA,Kin HJ.Decompression and nonfusion dynamic stabilization for spinal stenosis with degenerative lumbarscoliosis clinical article.J Neurosurg Spine,2014,21(4):585-594.
[9]何齐芳.腰椎非融合内固定结合椎间孔镜治疗多节段腰椎椎管狭窄症.中华全科医学,2015,13(7):1206-1209.
[10]Fleege C,Rickert M,Rauschmann M.The PLIF and TLIF.techniques.Indication,technique,advantages,and disadvantages.Orthopade,2015,44(2):114-123.
[11]Kulduk A,Altun NS,Senkoylu A.Biomechanical comparison of effects of the Dynesys and Coflex dynamic stabilization systems on range of motion and loading characteristics in the lumbar spine:a finite element study.Int J Med Robot,2015,11(4):400-405.
[12]何纯青,周武平,吴玲玲,等.Isobar动态固定联合腰椎融合术治疗腰椎退行性变疗效观察.海南医学,2015,26(15):2293-2295.
[13]Wu H,Pang Q,Jiang G.Medium-term effects of Dynesys dynamic stabilization versus posterior lumbar interbody fusion for treatment of multisegmental lumbar degenerative disease.J Int Med Res,2017,45(5):1562-1573.
[14]Hsieh CT,Chang CJ,Su IC,et al.Clinical experiences of dynamic stabilizers:Dynesys and Dynesys top loading system for lumbar spine degenerative disease.Kaohsiung J Med Sci,2016,32(4):207-215.
[15]高鑫峰,赵志刚,黄方敏,等.短节段减压融合内固定与Dynesysy治疗Lenke-SilvaⅡ级退行性脊柱侧凸症的疗效对比.中国矫形外科杂志,2017,25(13):1178-1183.
[16]Neukamp M,Roeder C,Veruva SY,et al.In vivo compatibility of Dynesys(?)spinal implants:a case series of five retrieved periprosthetic tissue samples and corresponding implants.Eur Spine J,2015,24(5):1074-1084.
[17]吴恙,李兴华,倪东亮,等.Dynesys动态内固定系统治疗腰椎退行性变病的临床疗效观察.中国矫形外科杂志,2016,24(1):78-81.
[18]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.中国矫形外科杂志,2017,25(11):1045-1047.
[19]Tsai TH,Kung SS,Huang TY,et al.Posterior dynamic stabilization system(Dynesys)with interbody fusion for treating two-segment lumbar degenerative disc disease.Formosan JSurg,2013,46(4):116-122.
[20]张增辉,李明才,李新春,等.髓核摘除联合Dynesys系统治疗老年腰椎间盘突出的疗效观察.浙江医学,2015,37(1):52-55.
[2]叶玉国,伍骥,郑超,等.L3-5节段退变性疾病融合与非融合术式的选择.安徽医科大学学报,2015,50(3):364-367.
[3]Lee JC,Kim Y,Soh JW,et al.Risk factors of adjacent segment disease requiring surgery after lumbar spinal fusion comparison of posterior lumbar interbody fusion and posterolateral fusion.Spine,2014,39(5):339-345.
[4]刘克骏,米明珊,白海明,等.腰椎退行性疾病Dynesys动态固定系统治疗的临床疗效.实用医学杂志,2016,(5)1006-5725.
[5]Liu C,Wang L,Tian JW.Early clinical effects of the Dynesys system plus transfacet decompression through the Wiltse approach for the treatment of lumbar degenerative diseases Med Sci Monit,2014,20:853-859.
[6]呂乔,刘卫华,程微,等.Dynesys动态内固定与融合术治疗腰椎退变疾病的对比研究.河北医学,2015,21(4):603-605.
[7]张增辉,李新春,李明才,等.髓核摘除联合Dynesys系统治疗老年腰椎间盘突出症的疗效观察.浙江医学,2015,37(1):52-55.
[8]Lee SE,Jahng TA,Kin HJ.Decompression and nonfusion dynamic stabilization for spinal stenosis with degenerative lumbarscoliosis clinical article.J Neurosurg Spine,2014,21(4):585-594.
[9]何齐芳.腰椎非融合内固定结合椎间孔镜治疗多节段腰椎椎管狭窄症.中华全科医学,2015,13(7):1206-1209.
[10]Fleege C,Rickert M,Rauschmann M.The PLIF and TLIF.techniques.Indication,technique,advantages,and disadvantages.Orthopade,2015,44(2):114-123.
[11]Kulduk A,Altun NS,Senkoylu A.Biomechanical comparison of effects of the Dynesys and Coflex dynamic stabilization systems on range of motion and loading characteristics in the lumbar spine:a finite element study.Int J Med Robot,2015,11(4):400-405.
[12]何纯青,周武平,吴玲玲,等.Isobar动态固定联合腰椎融合术治疗腰椎退行性变疗效观察.海南医学,2015,26(15):2293-2295.
[13]Wu H,Pang Q,Jiang G.Medium-term effects of Dynesys dynamic stabilization versus posterior lumbar interbody fusion for treatment of multisegmental lumbar degenerative disease.J Int Med Res,2017,45(5):1562-1573.
[14]Hsieh CT,Chang CJ,Su IC,et al.Clinical experiences of dynamic stabilizers:Dynesys and Dynesys top loading system for lumbar spine degenerative disease.Kaohsiung J Med Sci,2016,32(4):207-215.
[15]高鑫峰,赵志刚,黄方敏,等.短节段减压融合内固定与Dynesysy治疗Lenke-SilvaⅡ级退行性脊柱侧凸症的疗效对比.中国矫形外科杂志,2017,25(13):1178-1183.
[16]Neukamp M,Roeder C,Veruva SY,et al.In vivo compatibility of Dynesys(?)spinal implants:a case series of five retrieved periprosthetic tissue samples and corresponding implants.Eur Spine J,2015,24(5):1074-1084.
[17]吴恙,李兴华,倪东亮,等.Dynesys动态内固定系统治疗腰椎退行性变病的临床疗效观察.中国矫形外科杂志,2016,24(1):78-81.
[18]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.中国矫形外科杂志,2017,25(11):1045-1047.
[19]Tsai TH,Kung SS,Huang TY,et al.Posterior dynamic stabilization system(Dynesys)with interbody fusion for treating two-segment lumbar degenerative disc disease.Formosan JSurg,2013,46(4):116-122.
[20]张增辉,李明才,李新春,等.髓核摘除联合Dynesys系统治疗老年腰椎间盘突出的疗效观察.浙江医学,2015,37(1):52-55.