Dynesys治疗老年腰椎退行性疾病的中远期临床对照研究
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摘要
目的比较动态中和固定系统(Dynesys)及腰椎椎间融合内固定术(椎间融合术)治疗老年腰椎退行性疾病的疗效。方法采用Dynesys治疗65例老年腰椎退行性疾病患者(Dynesys组),并与同期接受单节段椎间融合术的70例同类患者(融合组)作比较,比较2组手术时间、术中出血量、住院日数以及手术疗效、术后Oswestry功能障碍指数(ODI)、疼痛视觉模拟评分(VAS)、术后手术节段和上位节段活动度的差异。结果 Dynesys组手术时间、术中出血量、住院日数均短/少于融合组(P均<0.05),而术后ODI和VAS 2组比较差异均无统计学意义(P均> 0.05)。2组随访时间为48～100个月。至末次随访时,Dynesys组和融合组患者的疼痛症状和神经功能均得到了明显改善,均未出现螺钉松动、断裂或腰椎移位。Dynesys组和融合组术后4年的优良率分别为93.15%和90.67%。Dynesys组术后手术节段活动度大于融合组(P <0.05),但2组术后上位节段活动度比较差异无统计学意义(P> 0.05)。融合组患者术后2例(2.9%)出现邻椎病,而Dynesys组患者均无出现邻椎病。结论术前严格把握手术适应证,Dynesys系统治疗老年腰椎退行性疾病的创伤较椎间融合术更小,术后并发症更少,恢复更快。
Objective To compare the clinical efficacy between dynamic neutralization system(Dynesys) and intervertebral fusion surgery in the treatment of senile lumbar degenerative diseases. Methods In the Dynesys group, 65 elderly patients with lumbar degenerative diseases were treated with Dynesys, and 70 patients undergoing intervertebral fusion surgery were assigned into the fusion group. The operation time, intraoperative bleeding, the length of hospital stay, surgical efficacy, Oswestry dysfunction index(ODI), visual analogue scale(VAS), postoperative movement of surgical segment and the upper segment were statistically compared between two groups. Results In the Dynesys group, the operation time, intraoperative bleeding and the length of hospital stay were significantly less than those in the fusion group(all P < 0.05), whereas postoperative ODI and VAS did not significantly differ between two groups(both P > 0.05). The follow-up time was 48-100 months. During the final follow-up, the pain symptoms and nerve function of patients in two groups were significantly improved without screw loosening, fracture or displacement. At postoperative 4 years, the clinical efficacy rates were 93.15% and 90.67% in the Dynesys and fusion groups. In the Dynesys group, the postoperative movement of the surgical segment was significantly larger than that in the fusion group(P < 0.05), whereas the postoperative movement of the upper segment did not significantly differ between two groups(P > 0.05). Two patients(2.9%) in the fusion group had adjacent vertebral diseases after operation, whereas no case was observed in the Dynesys group. Conclusions The surgical indications should be closely monitored before surgery. Dynesys yields less trauma, fewer complications and faster recovery in the treatment of senile lumbar degenerative diseases compared with intervertebral fusion surgery.
Objective To compare the clinical efficacy between dynamic neutralization system(Dynesys) and intervertebral fusion surgery in the treatment of senile lumbar degenerative diseases. Methods In the Dynesys group, 65 elderly patients with lumbar degenerative diseases were treated with Dynesys, and 70 patients undergoing intervertebral fusion surgery were assigned into the fusion group. The operation time, intraoperative bleeding, the length of hospital stay, surgical efficacy, Oswestry dysfunction index(ODI), visual analogue scale(VAS), postoperative movement of surgical segment and the upper segment were statistically compared between two groups. Results In the Dynesys group, the operation time, intraoperative bleeding and the length of hospital stay were significantly less than those in the fusion group(all P < 0.05), whereas postoperative ODI and VAS did not significantly differ between two groups(both P > 0.05). The follow-up time was 48-100 months. During the final follow-up, the pain symptoms and nerve function of patients in two groups were significantly improved without screw loosening, fracture or displacement. At postoperative 4 years, the clinical efficacy rates were 93.15% and 90.67% in the Dynesys and fusion groups. In the Dynesys group, the postoperative movement of the surgical segment was significantly larger than that in the fusion group(P < 0.05), whereas the postoperative movement of the upper segment did not significantly differ between two groups(P > 0.05). Two patients(2.9%) in the fusion group had adjacent vertebral diseases after operation, whereas no case was observed in the Dynesys group. Conclusions The surgical indications should be closely monitored before surgery. Dynesys yields less trauma, fewer complications and faster recovery in the treatment of senile lumbar degenerative diseases compared with intervertebral fusion surgery.
引文
[1]张增辉,李新春,李明才,王毳,任甜甜,肖进,司全明,密云峰.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
[2]Zhang C,Wang L,Hou T,Luo L,Zhao C,Gan Y,Zhou Q,Li P.The influence of L4-S1 Dynesys?dynamic stabilization versus fusion on lumbar motion and its relationship with lumbar degeneration:a retrospective study.J Orthop Surg Res,2017.12(1):99.
[3]Watts NB.Long-term risks of bisphosphonate therapy.Arq Bras Endocrinol Metabol,2014.58(5):523-529.
[4]胡有谷.腰椎间盘突出症.3版.北京:人民卫生出版社,2005:221,282.
[5]Haddad B,Makki D,Konan S,Park D,Khan W,Okafor B.Dynesys dynamic stabilization:less good outcome than lumbar fusion at 4-year follow-up.Acta Orthop Belg,2013.79(1):97-103.
[6]Payer M,Smoll NR,Nicolas S,Oezkan N,Tessitore E.Dynamic transpedicular stabilisation and decompression in single-level degenerative anterolisthesis and stenosis.Acta Neurochir(Wien),2014,156(2):221-227.
[7]Lee SE,Jahng TA,Kim HJ.Decompression and nonfusion dynamic stabilization for spinal stenosis with degenerative lumbar scoliosis:clinical article.J Neurosurg Spine,2014,21(4):585-594.
[8]Di SM,Lolli F,Bakaloudis G.Degenerative lumbar scoliosis in elderly patients:dynamic stabilization without fusion versus posterior instrumented fusion.Spine J,2014,14(1):1-10.
[9]Fei H,Xu J,Wang S,Xie Y,Ji F,Xu Y.Comparison between posterior dynamic stabilization and posterior lumbar interbody fusion in the treatment of degenerative disc disease:a prospective cohort study.J Orthop Surg Res,2015,10:87.
[10]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.
[11]吴海挺,蒋国强,卢斌,罗科锋,岳兵,陆继业.Dynesys与PLIF治疗单节段腰椎间盘突出症隐性失血的临床研究.新医学,2015,46(1):36-39.
[12]Lee CH,Jahng TA,Hyun SJ,Kim CH,Park SB,Kim KJ,Chung CK,Kim HJ,Lee SE.Dynamic stabilization using the Dynesys system versus posterior lumbar interbody fusion for the treatment of degenerative lumbar spinal disease:a clinical and radiological outcomes-based meta-analysis.Neurosurg Focus,2016,40(1):E7.
[13]Gu G,Wang C,Gu X,Zhang H,Zhao Y,He S.Percutaneous transforaminal endoscopic discectomy for adjacent segment disease after lumbar fusion in elderly patients over 65 years old.World Neurosurg,2018,112:e830-e836.
[2]Zhang C,Wang L,Hou T,Luo L,Zhao C,Gan Y,Zhou Q,Li P.The influence of L4-S1 Dynesys?dynamic stabilization versus fusion on lumbar motion and its relationship with lumbar degeneration:a retrospective study.J Orthop Surg Res,2017.12(1):99.
[3]Watts NB.Long-term risks of bisphosphonate therapy.Arq Bras Endocrinol Metabol,2014.58(5):523-529.
[4]胡有谷.腰椎间盘突出症.3版.北京:人民卫生出版社,2005:221,282.
[5]Haddad B,Makki D,Konan S,Park D,Khan W,Okafor B.Dynesys dynamic stabilization:less good outcome than lumbar fusion at 4-year follow-up.Acta Orthop Belg,2013.79(1):97-103.
[6]Payer M,Smoll NR,Nicolas S,Oezkan N,Tessitore E.Dynamic transpedicular stabilisation and decompression in single-level degenerative anterolisthesis and stenosis.Acta Neurochir(Wien),2014,156(2):221-227.
[7]Lee SE,Jahng TA,Kim HJ.Decompression and nonfusion dynamic stabilization for spinal stenosis with degenerative lumbar scoliosis:clinical article.J Neurosurg Spine,2014,21(4):585-594.
[8]Di SM,Lolli F,Bakaloudis G.Degenerative lumbar scoliosis in elderly patients:dynamic stabilization without fusion versus posterior instrumented fusion.Spine J,2014,14(1):1-10.
[9]Fei H,Xu J,Wang S,Xie Y,Ji F,Xu Y.Comparison between posterior dynamic stabilization and posterior lumbar interbody fusion in the treatment of degenerative disc disease:a prospective cohort study.J Orthop Surg Res,2015,10:87.
[10]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.
[11]吴海挺,蒋国强,卢斌,罗科锋,岳兵,陆继业.Dynesys与PLIF治疗单节段腰椎间盘突出症隐性失血的临床研究.新医学,2015,46(1):36-39.
[12]Lee CH,Jahng TA,Hyun SJ,Kim CH,Park SB,Kim KJ,Chung CK,Kim HJ,Lee SE.Dynamic stabilization using the Dynesys system versus posterior lumbar interbody fusion for the treatment of degenerative lumbar spinal disease:a clinical and radiological outcomes-based meta-analysis.Neurosurg Focus,2016,40(1):E7.
[13]Gu G,Wang C,Gu X,Zhang H,Zhao Y,He S.Percutaneous transforaminal endoscopic discectomy for adjacent segment disease after lumbar fusion in elderly patients over 65 years old.World Neurosurg,2018,112:e830-e836.