動態中和系統與后路腰椎椎間融合治療腰椎退行性變的比較研究_《中國修復重建外科雜志》

作者：

楊兵 , 江庭彪

玉林市骨科醫院骨一科（廣西玉林，537000）;

關鍵詞：

腰椎退行性變動態中和系統后路腰椎椎間融合

DOI：

10.7507/1002-1892.20130032

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目的探討動態中和系統（dynamic neutralization system，Dynesys）治療腰椎退行性變的近期療效，比較與后路腰椎椎間融合（posterior lumbar interbody fusion，PLIF）的療效差異。方法回顧性分析2009年2月－2011年3月分別采用 Dynesys（14例）和PLIF（18例）治療的腰椎退行性變患者臨床資料。兩組患者性別、年齡、病程、病變類型、病變節段等比較，差異均無統計學意義（P gt; 0.05），具有可比性。對兩組術前及末次隨訪時疼痛視覺模擬評分（VAS）、Oswestry功能障礙指數（ODI）和影像學評估結果進行比較分析。結果術后31例獲隨訪，隨訪時間12～21 個月，平均17個月。隨訪期間兩組均無內固定物松動、斷釘、斷棒、斷索等并發癥發生。PLIF組椎間均骨性融合或接近融合，融合時間13～19個月，平均15個月。兩組末次隨訪時VAS評分、ODI均較術前顯著改善（P lt; 0.05）；術前及末次隨訪時兩組間比較差異均無統計學意義（P gt; 0.05）。影像學評估：末次隨訪時PLIF組手術節段活動度（range of motion，ROM）為（0.1 ± 0.4）°，與術前（7.0 ± 0.6）°比較差異有統計學意義（t=28.500，P=0.004）；Dynesys組手術節段ROM（5.0 ± 1.5）°較術前（7.5 ± 0.8）°減少，但差異無統計學意義（t=0.480，P=0.113）；末次隨訪時兩組間比較差異有統計學意義（t=5.260，P=0.008）。末次隨訪時Dynesys組鄰近節段ROM（7.2 ± 0.7）°較術前（7.3 ± 1.8）°減小，但差異無統計學意義（t=0.510，P=0.108）；PLIF組鄰近節段ROM（8.7 ± 0.4）°較術前（7.0 ± 1.6）°明顯增加，差異有統計學意義（t=3.440，P=0.042）；末次隨訪時兩組間比較差異有統計學意義（t= —2.100，P=0.047）。結論Dynesys與PLIF治療腰椎退行性變的近期療效相當，但Dynesys具有保留手術節段ROM、不增加鄰近節段ROM的優勢，同時具有促進手術節段椎間盤恢復、預防相鄰節段退變的積極作用。

引用本文： 楊兵,江庭彪. 動態中和系統與后路腰椎椎間融合治療腰椎退行性變的比較研究. 中國修復重建外科雜志, 2013, 27(2): 140-144. doi: 10.7507/1002-1892.20130032 復制

1.	Stoll TM, Dubois G, Schmarzenhach O. The dynamic neutralization system for the spine: a multi-center study of a novel non-fusion system. Eur Spine J, 2002, 11 Suppl 2: S170-178.
2.	Schmoelz W, Huber JF, Nydegger T, et al. Influence of a dynamic stabilization system on load bearing of a bridged disc: an in vitro study of intradiscal pressure. Eur Spine J, 2006, 15(8): 1276-1285.
3.	Schmoelz W, Huber JF, Nydegger T, et al. Dynamic stabilization of the lumbar spine and its effects on adjacent segments: an in vitro experiment. J Spinal Disord Tech, 2003, 16(4): 418-423.
4.	Grob D, Benini A, Junge A, et al. Clinical expenience with the Dynesys semirigid fixation system for the lumbar spine: surgical and patient- onentel outcome in 50 cases after an average of 2 years. Spine (Phila Pa 1976), 2005, 30(3): 324-331.
5.	Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976), 2000, 25(22): 2940-2952.
6.	Gibson JN, Grant IC, Waddell G. The cochrane review of srugery for lumbar disc prolapse and degenerative lumbar spondylosis. Spine (Phila Pa 1976), 1999, 24(17): 1820-1832.
7.	Kumar MN, Baklanov A, Chopin D. Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. Eur Spine J, 2001, 10(4): 314-319.
8.	梁春紅, 丁亮華, 吳采榮, 等. Dynesys動態穩定系統與腰椎退變性疾病. 國際骨科學雜志, 2009, 30(5): 320-322.
9.	Dubois G. Dynamic stabilization with the Dynesys system and the dynamic transition option DTO implant: philosophy-concept surgical technique. Interact Surg, 2008, 3(4): 239-244.
10.	Cakir B, Carazzo C, Schmidt R, et al. Adjacent segment mobility after rigid seminigid instramentation of lumbar spine. Spine (Phila Pa 1976), 2009, 34(12): 1278-1291.
11.	Vaga S, Brayda-Bruno M, Perona F, et al. Molecular MR imaging for the evaluation of the effect of dynamic stabilization on lumbar intervertebral discs. Eue Spine J, 2009, 18 Suppl 1: 40-48.
12.	Würgler-Hauri CC, Kalbarczyk A, Wiesli M, et al. Dynamic neutralization of the lumbar spine after microsurgical decompression in acquired lumbar spinal stenosis and segmental instability. Spine (Phila Pa 1976), 2008, 33(3): E66-72.
13.	Bordes-Monmeneu M, Bordes-Garcia V, Rodrigo-Baeza F, et al. System of dynamic neutralization in the lumbar spine: experience on 94 cases. Neurocirugia (Astur), 2005, 16(6): 499-506.
14.	Putzier M, Schneider SV, Funk J, et al. Application of a dynamicpedicle screw system (DYNESYS) for lumbar segmental degenerations-comparison of clinical and radiological results for different indications. Z Orthop Ihre Grenzgeb, 2004, 142(2): 166-173.
15.	Schmoelz W, Huber JF, Nydegger T, et al. Dynamic stabilization of the lumbar spine and its effects on adjacent segments: an in vitro experiment. J Spinal Disord Tech, 2003, 16(4): 418-423.
16.	殷渠東, Jeanneret B. Dynesys 治療腰椎退變和不穩(附13例報告). 中國矯形外科雜志, 2007, 7(15): 491-493.
17.	Ko CC, Tsai HW, Huang WC, et al. Screw loosening in the Dynesys stabilization system: radiographic evidence and effect on outcomes. Neurosurg Focus, 2010, 28(6): E10.

1. Stoll TM, Dubois G, Schmarzenhach O. The dynamic neutralization system for the spine: a multi-center study of a novel non-fusion system. Eur Spine J, 2002, 11 Suppl 2: S170-178.
2. Schmoelz W, Huber JF, Nydegger T, et al. Influence of a dynamic stabilization system on load bearing of a bridged disc: an in vitro study of intradiscal pressure. Eur Spine J, 2006, 15(8): 1276-1285.
3. Schmoelz W, Huber JF, Nydegger T, et al. Dynamic stabilization of the lumbar spine and its effects on adjacent segments: an in vitro experiment. J Spinal Disord Tech, 2003, 16(4): 418-423.
4. Grob D, Benini A, Junge A, et al. Clinical expenience with the Dynesys semirigid fixation system for the lumbar spine: surgical and patient- onentel outcome in 50 cases after an average of 2 years. Spine (Phila Pa 1976), 2005, 30(3): 324-331.
5. Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976), 2000, 25(22): 2940-2952.
6. Gibson JN, Grant IC, Waddell G. The cochrane review of srugery for lumbar disc prolapse and degenerative lumbar spondylosis. Spine (Phila Pa 1976), 1999, 24(17): 1820-1832.
7. Kumar MN, Baklanov A, Chopin D. Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. Eur Spine J, 2001, 10(4): 314-319.
8. 梁春紅, 丁亮華, 吳采榮, 等. Dynesys動態穩定系統與腰椎退變性疾病. 國際骨科學雜志, 2009, 30(5): 320-322.
9. Dubois G. Dynamic stabilization with the Dynesys system and the dynamic transition option DTO implant: philosophy-concept surgical technique. Interact Surg, 2008, 3(4): 239-244.
10. Cakir B, Carazzo C, Schmidt R, et al. Adjacent segment mobility after rigid seminigid instramentation of lumbar spine. Spine (Phila Pa 1976), 2009, 34(12): 1278-1291.
11. Vaga S, Brayda-Bruno M, Perona F, et al. Molecular MR imaging for the evaluation of the effect of dynamic stabilization on lumbar intervertebral discs. Eue Spine J, 2009, 18 Suppl 1: 40-48.
12. Würgler-Hauri CC, Kalbarczyk A, Wiesli M, et al. Dynamic neutralization of the lumbar spine after microsurgical decompression in acquired lumbar spinal stenosis and segmental instability. Spine (Phila Pa 1976), 2008, 33(3): E66-72.
13. Bordes-Monmeneu M, Bordes-Garcia V, Rodrigo-Baeza F, et al. System of dynamic neutralization in the lumbar spine: experience on 94 cases. Neurocirugia (Astur), 2005, 16(6): 499-506.
14. Putzier M, Schneider SV, Funk J, et al. Application of a dynamicpedicle screw system (DYNESYS) for lumbar segmental degenerations-comparison of clinical and radiological results for different indications. Z Orthop Ihre Grenzgeb, 2004, 142(2): 166-173.
15. Schmoelz W, Huber JF, Nydegger T, et al. Dynamic stabilization of the lumbar spine and its effects on adjacent segments: an in vitro experiment. J Spinal Disord Tech, 2003, 16(4): 418-423.
16. 殷渠東, Jeanneret B. Dynesys 治療腰椎退變和不穩(附13例報告). 中國矯形外科雜志, 2007, 7(15): 491-493.
17. Ko CC, Tsai HW, Huang WC, et al. Screw loosening in the Dynesys stabilization system: radiographic evidence and effect on outcomes. Neurosurg Focus, 2010, 28(6): E10.

《中國修復重建外科雜志》

動態中和系統與后路腰椎椎間融合治療腰椎退行性變的比較研究

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《中國修復重建外科雜志》

動態中和系統與后路腰椎椎間融合治療腰椎退行性變的比較研究

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