摘要
目的:评估Dynesys动态内固定系统、融合内固定术、椎板开窗髓核摘除术治疗腰4/5椎间盘突出症的疗效。方法:回顾性分析2010年9月至2013年9月收治的腰4/5单一节段退变的患者82例,按照手术方式分组,其中采用Dynesys动态固定26例(A组),融合内固定术32例(B组),椎板开窗髓核摘除组24例(C组),随访时间2~3年,平均2.4年。应用0swestry功能障碍指数(ODI),疼痛视觉模拟评分(VAS)评价患者术后症状改善情况。手术节段椎间高度、活动度(ROM)及头、尾侧邻近节段活动度评价术后临近节段退变情况。结果:C组手术时间短、出血量显著少于其他二组(P<0.05),A组以上两个指标显著低于融合固定组(P<0.05)。三组末次随访VAS、ODI评分均较术前明显改善(P<0.05),三组间差异无统计学意义(P>0.05)。三组手术节段椎间高度术前无显著差异(P>0.05),末次随访动态固定组、融合组均较术前显著升高,C组较术前降低(P<0.05)。末次随访手术节段ROMC组较术前无明显变化(P>0.05),A组、B组均较术前显著降低(P<0.05)。术前临近节段ROMA组、B组、C组间对比无显著差异(P>0.05),末次随访A组、B组ROM较术前升高(P<0.05),C组较术前无显著差异(P>0.05)。结论:三种开放手术方式均能取得良好疗效。在手术时间和出血量方面开窗髓核摘除术优于其他两种术式。融合固定和Dynesys在撑开病变椎间隙方面效果肯定。开窗髓核摘除、Dynesys都可以保留一部分病变节段活动度,但后者可在保留病变节段活动和维持稳定间达到更好的平衡,有效的防止病变节段继续退变。
Objective:To evaluate the clinical and radiographic results of three surgical methods namely dynesys,discectomy,and spinal fusion and internal fixation in the treatment of lumbar degenerative disease.Memods:Among the 82 cases of lurnbar degenerative disease from July 2010 to July 2013,26 patients were treated with Dynesys procedure(Group A),32 with spinal fusion and internal fixation(Group B)and 24 with discectomy(Group C).The follow-up periods were made between 2 and 3 years,an average of 2.4 years.Clinical outcomes in term of range of motion(ROM),intervenebral height of lumbar segments and ROM of adjacent segment were evaluated by visual analogue scale(VAS)and 0swestry disability index(ODI).Results:Group C with discectomy was much less than the other two(P<0.05)in terms of operation time and amount of bleeding while Group A with Dynesys was lower than the Group treated with spinal fusion and internal fixation(P<0.05).All 3 groups at the last follow-up have seen significant improvements in VAS and ODI figures compared with the numbers before operation(P<0.05)and the disparity among them makes no difference statistically(p>0.05).The intervenebral heights of lumbar segments for the three had not shown any dramatic variation before surgery(p>0.05)while the figure of Group B with spinal fusion and internal fixation increased significantly and the one of Group C dropped at the last follow-up(P<0.05).At the last follow-up the ROM of Group C had barely changed significantly compared with preoperative period(p>0.05)while the spinal fusion and internal fixation group and the Dynesys group decreased remarkably(P<0.05).During the preoperative period,there were no marked disparity in ROM of adjacent segment among the three groups(p>0.05)while at the last follow-up Group B with spinal fusion and internal fixation and Group C with Dynesys have both increased compared with their preoperative figures(P<0.05)and the discectomy group has remained unchanged(p>0.05).Conclusions:The three methods can all produce good results.Considering operation time and amount of bleeding discectomy is better than the other two groups;spinal fusion and internal fixation and Dynesys are more preferred than discectomy in opening lesion segments;and discectomy and Dynesys can equally maintain the ROM of parts of lesion segments,but the latter can achieve a better balance between ROM and stability,preventing effectively further lesion segment degeneration.
作者
马树伟
吴继功
MA Shuwei;WU Jigong(PLA 306th Hospital,BeiJing 100101,China)
出处
《河北医学》
CAS
2018年第7期1155-1161,共7页
Hebei Medicine
