Dynesys動態(tài)中和系統(tǒng)治療腰椎退行性疾病的臨床療效及影像學(xué)分析
發(fā)布時間：2018-09-17 07:38
【摘要】：目的觀察Dynesys動態(tài)中和系統(tǒng)治療腰椎退行性疾病的早期臨床療效;分析Dynesys動態(tài)固定術(shù)后腰椎節(jié)段的放射學(xué)變化;通過對殘留椎間盤的再水化現(xiàn)象分析初步探討Dynesys動態(tài)固定對退變椎間盤的修復(fù)作用。方法:回顧性分析2011年12月至2013年10月在我院接受手術(shù)治療的89例腰椎間盤退行性疾病患者資料,按手術(shù)方式分為Dynesys動態(tài)固定組(Dynesys dynamic fixation,Dynesys組)與后路腰椎間融合組(posterior lumbar interbody fusion,PLIF組),其中Dynesys組38例,男性27例,女性11例,平均(37.66±9.58)歲;PLIF組51例,男性35例,女性16例,平均(40.53±11.72)歲。評估兩組患者術(shù)前及末次隨訪時腰腿痛VAS、ODI評分,采用腰椎X片測量手術(shù)節(jié)段及鄰近節(jié)段椎間隙前后方高度、屈伸活動度(range of motion,ROM)及腰椎前凸角(L1-L5);利用腰椎MRI計(jì)算手術(shù)節(jié)段椎間盤平均標(biāo)準(zhǔn)椎間盤信號(calibrated disc signal,CDS)。結(jié)果:89例患者術(shù)后隨訪14月~37月,平均(25.11±6.96)個月。所有患者均在末次隨訪時復(fù)查腰椎X線,Dynesys組中23例病人末次隨訪時獲得腰椎MRI復(fù)查。末次隨訪時,兩組患者腰腿痛VAS評分和ODI指數(shù)較術(shù)前均有明顯改善(P0.05)。與術(shù)前相比,Dynesys組手術(shù)節(jié)段椎間隙前、后緣高度明顯降低(P0.05);兩組上位鄰近節(jié)段椎間隙前緣高度無顯著變化(P0.05),但后緣高度均顯著丟失(P0.05);兩組下位鄰近節(jié)段椎間隙前后緣高度及腰椎前凸角均無明顯改變。末次隨訪Dynesys組手術(shù)節(jié)段屈伸ROM(2.90±1.72)°比術(shù)前(5.31±2.60)°明顯減少(P0.05),但仍保留術(shù)前ROM的64.11%,上下相鄰節(jié)段及腰椎整體ROM較術(shù)前無統(tǒng)計(jì)學(xué)差異;而PLIF組上位相鄰節(jié)段ROM由術(shù)前(5.64±2.79)°明顯增加至(7.76±3.15)°,存在統(tǒng)計(jì)學(xué)差異(P0.05),下位相鄰節(jié)段及腰椎整體ROM較術(shù)前無顯著變化(P0.05)。Dynesys組中23名患者接受腰椎MRI復(fù)查,平均CDS由術(shù)前42.74%±13.15%改善至47.69%±14.38%,差異有統(tǒng)計(jì)學(xué)意義(P=0.004)。結(jié)論:與融合術(shù)相比,Dynesys動態(tài)中和系統(tǒng)同樣是一種有效的、可選擇的治療腰椎退行性疾病的手術(shù)方式;Dynesys系統(tǒng)保留了固定節(jié)段一定ROM,不引起鄰近節(jié)段過度活動;同時,殘留椎間盤出現(xiàn)再水化,表明其可能具有促進(jìn)退變椎間盤修復(fù)的作用。但是,Dynesys非融合術(shù)后存在明顯的手術(shù)節(jié)段椎間隙高度丟失以及上位鄰近節(jié)段代償性前凸等問題,有待進(jìn)一步長期隨訪觀察。
[Abstract]:Objective to observe the early clinical effect of Dynesys dynamic neutralization system in the treatment of lumbar degenerative diseases and to analyze the radiologic changes of lumbar segment after Dynesys dynamic fixation. By analyzing the rehydration phenomenon of residual intervertebral disc, the effect of Dynesys dynamic fixation on the repair of degenerative intervertebral disc was preliminarily discussed. Methods: the data of 89 patients with degenerative lumbar disc disease who received surgical treatment in our hospital from December 2011 to October 2013 were analyzed retrospectively. The patients were divided into two groups according to the operative method: (Dynesys dynamic fixation,Dynesys group (n = 38) and (posterior lumbar interbody fusion,PLIF group (n = 16). There were 38 cases of Dynesys group (male 27 cases, female 11 cases, mean (37.66 鹵9.58) years old) 51 cases (male 35 cases, female 16 cases, mean 40.53 鹵11.72 years old). The VAS,ODI score of lumbago and leg pain was evaluated before and at the last follow-up in both groups. The anterior and posterior height of the surgical segment and adjacent intervertebral space were measured by lumbar X ray. Flexion and extension (range of motion,ROM) and Lumbar kyphosis (L1-L5), and MRI was used to calculate the mean signal (calibrated disc signal,CDS of lumbar intervertebral disc. Results the follow-up of 89 cases was from 14 months to 37 months, with an average of (25.11 鹵6.96) months. All the patients received lumbar MRI reexamination at the last follow-up in 23 patients in the lumbar X-ray Dynesys group. At the last follow-up, the VAS score and ODI index of lumbago and leg pain in both groups were significantly improved compared with those before operation (P0.05). Compared with before operation, the segmental intervertebral space in Dynesys group was preoperatively. The posterior edge height was significantly decreased (P0.05); there was no significant change in the anterior edge height of upper adjacent segments in both groups (P0.05), but the posterior edge height was significantly lost (P0.05); the anterior and posterior edge height and lumbar lordosis angle were not significantly changed in the two groups. In the last follow-up Dynesys group, the flexion and extension ROM (2.90 鹵1.72) 擄decreased significantly compared with the preoperative (5.31 鹵2.60) 擄(P0.05), but the preoperative ROM was retained at 64.11%. There was no significant difference between the upper and lower adjacent segments and the whole ROM of the lumbar vertebrae. In the PLIF group, the upper adjacent segment ROM increased from (5.64 鹵2.79) 擄to (7.76 鹵3.15) 擄, there was statistical difference (P 0.05). There was no significant change in the inferior adjacent segment and lumbar whole ROM compared with the preoperative (P0.05). The 23 patients in the dyesys group received MRI reexamination of lumbar vertebrae. The average CDS was improved from 42.74% 鹵13.15% to 47.69% 鹵14.38% (P0. 004). Conclusion: compared with fusion, dynesys dynamic neutralization system is also an effective method for the treatment of lumbar degenerative diseases. The Dynesys system retains a fixed segment of ROM, and does not cause hyperactivity in adjacent segments. The rehydration of the residual intervertebral disc suggests that it may promote the repair of degenerative intervertebral disc. However, the loss of height of intervertebral space and the compensatory protruding of superior adjacent segment after Dynesys non-fusion surgery are obvious problems, which need to be followed up for a long time.
【學(xué)位授予單位】：暨南大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3
本文編號：2245183
[Abstract]:Objective to observe the early clinical effect of Dynesys dynamic neutralization system in the treatment of lumbar degenerative diseases and to analyze the radiologic changes of lumbar segment after Dynesys dynamic fixation. By analyzing the rehydration phenomenon of residual intervertebral disc, the effect of Dynesys dynamic fixation on the repair of degenerative intervertebral disc was preliminarily discussed. Methods: the data of 89 patients with degenerative lumbar disc disease who received surgical treatment in our hospital from December 2011 to October 2013 were analyzed retrospectively. The patients were divided into two groups according to the operative method: (Dynesys dynamic fixation,Dynesys group (n = 38) and (posterior lumbar interbody fusion,PLIF group (n = 16). There were 38 cases of Dynesys group (male 27 cases, female 11 cases, mean (37.66 鹵9.58) years old) 51 cases (male 35 cases, female 16 cases, mean 40.53 鹵11.72 years old). The VAS,ODI score of lumbago and leg pain was evaluated before and at the last follow-up in both groups. The anterior and posterior height of the surgical segment and adjacent intervertebral space were measured by lumbar X ray. Flexion and extension (range of motion,ROM) and Lumbar kyphosis (L1-L5), and MRI was used to calculate the mean signal (calibrated disc signal,CDS of lumbar intervertebral disc. Results the follow-up of 89 cases was from 14 months to 37 months, with an average of (25.11 鹵6.96) months. All the patients received lumbar MRI reexamination at the last follow-up in 23 patients in the lumbar X-ray Dynesys group. At the last follow-up, the VAS score and ODI index of lumbago and leg pain in both groups were significantly improved compared with those before operation (P0.05). Compared with before operation, the segmental intervertebral space in Dynesys group was preoperatively. The posterior edge height was significantly decreased (P0.05); there was no significant change in the anterior edge height of upper adjacent segments in both groups (P0.05), but the posterior edge height was significantly lost (P0.05); the anterior and posterior edge height and lumbar lordosis angle were not significantly changed in the two groups. In the last follow-up Dynesys group, the flexion and extension ROM (2.90 鹵1.72) 擄decreased significantly compared with the preoperative (5.31 鹵2.60) 擄(P0.05), but the preoperative ROM was retained at 64.11%. There was no significant difference between the upper and lower adjacent segments and the whole ROM of the lumbar vertebrae. In the PLIF group, the upper adjacent segment ROM increased from (5.64 鹵2.79) 擄to (7.76 鹵3.15) 擄, there was statistical difference (P 0.05). There was no significant change in the inferior adjacent segment and lumbar whole ROM compared with the preoperative (P0.05). The 23 patients in the dyesys group received MRI reexamination of lumbar vertebrae. The average CDS was improved from 42.74% 鹵13.15% to 47.69% 鹵14.38% (P0. 004). Conclusion: compared with fusion, dynesys dynamic neutralization system is also an effective method for the treatment of lumbar degenerative diseases. The Dynesys system retains a fixed segment of ROM, and does not cause hyperactivity in adjacent segments. The rehydration of the residual intervertebral disc suggests that it may promote the repair of degenerative intervertebral disc. However, the loss of height of intervertebral space and the compensatory protruding of superior adjacent segment after Dynesys non-fusion surgery are obvious problems, which need to be followed up for a long time.
【學(xué)位授予單位】：暨南大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3
【參考文獻(xiàn)】
相關(guān)期刊論文 前2條
1 張?jiān)?孫天勝;姚紅;;Dynesys system技術(shù)以及PLIF技術(shù)治療腰椎間盤突出癥隱性失血的臨床分析[J];中國矯形外科雜志;2014年05期
2 梁廣勝;殷明;劉玉亮;魏強(qiáng)強(qiáng);周榮平;殷嫦嫦;;Wnt信號通路與椎間盤的發(fā)展[J];中國矯形外科雜志;2014年05期
，本文編號：2245183
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