[1]王利元,张承旻,罗磊,等.Dynesys动态固定系统用于腰椎多节段退行性疾病的2年随访临床疗效观察[J].第三军医大学学报,2017,39(11):1165-1170.
 Wang Liyuan,Zhang Chengmin,Luo Lei,et al.Clinical efficacy of Dynesys dynamic stabilization system for multi-segment lumbar degenerative disease: a report based on 2-year follow-up[J].J Third Mil Med Univ,2017,39(11):1165-1170.
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Dynesys动态固定系统用于腰椎多节段退行性疾病的2年随访临床疗效观察(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
39卷
期数:
2017年第11期
页码:
1165-1170
栏目:
临床医学
出版日期:
2017-06-15

文章信息/Info

Title:
Clinical efficacy of Dynesys dynamic stabilization system for multi-segment lumbar degenerative disease: a report based on 2-year follow-up
作者:
王利元张承旻罗磊赵晨侯天勇罗飞代飞何清义周强
第三军医大学西南医院全军矫形外科中心,组织工程国家地方联合工程实验室,全军骨组织工程重点实验室
Author(s):
Wang Liyuan Zhang Chengmin Luo Lei Zhao Chen Hou Tianyong Luo Fei Dai Fei He Qingyi Zhou Qiang

Center of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China

关键词:
腰椎退行性疾病多节段Dynesys动态固定系统腰椎融合术邻椎病
Keywords:
lumbar degenerative disease multi-segment Dynesys dynamic stabilization system lumbar fusion adjacent segment disease
分类号:
R615; R681.53; R687.3
文献标志码:
A
摘要:

目的       通过对比分析评估Dynesys动态固定系统与融合术在腰椎多节段退行性疾病治疗中的临床疗效及对腰椎运动功能的影响。方法       收集2013年1月至2014年5月在我院行多节段Dynesys动态固定及融合术的51例患者的临床资料,其中Dynesys动态固定组24例,融合组27例。应用腰椎疼痛视觉模拟指数评分(visual analogue scale,VAS)、腰椎功能评分(oswestry disability index,ODI)评估临床疗效;对比分析两种术式术前及术后6、12、24个月腰椎整体活动度、手术节段活动度、邻近第一椎间活动度、邻近第一椎间高度、邻椎病(adjacent segment disease,ASD)的发生率,评估两种术式对腰椎运动功能的影响。结果       51例患者均获得完整随访,平均随访26.2(23~31)个月。两组病例VAS评分及ODI评分术后各时间点与术前相比均明显下降,差异有统计学意义(P<0.05),术后6个月组间比较差异有统计学意义(P<0.05),其余各时间点组间比较差异无统计学意义。Dynesys动态固定组术后较融合组保留了更多的腰椎整体活动度,差异有统计学意义(P<0.01)。Dynesys动态固定组术后保留了部分手术节段的活动度,融合组因融合而丢失活动度,组间比较差异有统计学意义(P<0.01)。术后24个月两组病例邻近上一椎间活动度差异有统计学意义(P<0.01),邻近上一椎间高度组间及组内各时间点比较差异无统计学意义。在ASD方面,融合组3例出现邻近节段不稳,但无明显临床症状,未行临床干预。结论       Dynesys动态固定系统治疗腰椎多节段退行性疾病具有良好的临床疗效,同时保留了更多的活动度,减缓ASD的发生,可以作为一种较好的手术治疗选择。
 

Abstract:

Objective       To evaluate the clinical efficacy and lumbar motion function of Dynesys dynamic stabilization system and fusion in the treatment of lumbar multi-segment degenerative diseases by comparative analysis. Methods       A total of 51 patients undergoing surgery for multisegment stabilization and fusion in our hospital from January 2013 to May 2014 were enrolled in this study. There were 24 patients undergoing Dynesys dynamic stabilization and 27 fusion. Visual ananalogue scale (VAS) was used to measure the low back pain, and Oswestry disability index (ODI) was employed to assess the function of lumbar vertebra. Lumbar motion function was evaluated by comparing the range of motion (ROM) of whole lumbar spine and surgical segments, ROM of the upper adjacent segments, height of the upper adjacent segments, the incidence of adjacent segment disease (ASD) between the 2 groups of patients preoperatively and in 6, 12 and 24 months postoperatively. Results        All the patients were followed up for an average time of 26.2 (23~31) months (P<0.05). The VAS scores and the ODI scores were significantly improved in the 2 groups at all the postoperative time points (P<0.05). There were significant differences in the scores between the 2 groups in 6 month postoperatively (P<0.05), but no such difference at other time points. The Dynesys dynamic stabilization group retained more degrees of motion than the fusion group (P<0.01), and some of the surgical segment activity, but the fusion group lost the activity due to fusion (P<0.01). Significant difference was seen in the ROM of the upper adjacent segments between the 2 groups in 24 months postoperatively (P<0.01), but no difference was observed in the mean height of the intervertebral space between the 2 groups and at each time point. In ASD, 3 cases of fusion group showed instability of upper adjacent segments, but without obvious clinical symptoms, and no clinical intervention was carried out. Conclusion       Dynesys dynamic stabilization system shows a good clinical outcome, retains more activity, and reduces the occurrence of ASD in the treatment of lumbar multi-level degenerative disease. So it should be used as a better surgical option.

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更新日期/Last Update: 2017-06-09