动态中和系统与后路腰椎椎间融合治疗腰椎退行性变的比较研究_《中国修复重建外科杂志》

作者：

杨兵 , 江庭彪

玉林市骨科医院骨一科（广西玉林，537000）;

关键词：

腰椎退行性变动态中和系统后路腰椎椎间融合

DOI：

10.7507/1002-1892.20130032

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的探讨动态中和系统（dynamic neutralization system，Dynesys）治疗腰椎退行性变的近期疗效，比较与后路腰椎椎间融合（posterior lumbar interbody fusion，PLIF）的疗效差异。方法回顾性分析2009年2月－2011年3月分别采用 Dynesys（14例）和PLIF（18例）治疗的腰椎退行性变患者临床资料。两组患者性别、年龄、病程、病变类型、病变节段等比较，差异均无统计学意义（P gt; 0.05），具有可比性。对两组术前及末次随访时疼痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）和影像学评估结果进行比较分析。结果术后31例获随访，随访时间12～21 个月，平均17个月。随访期间两组均无内固定物松动、断钉、断棒、断索等并发症发生。PLIF组椎间均骨性融合或接近融合，融合时间13～19个月，平均15个月。两组末次随访时VAS评分、ODI均较术前显著改善（P lt; 0.05）；术前及末次随访时两组间比较差异均无统计学意义（P gt; 0.05）。影像学评估：末次随访时PLIF组手术节段活动度（range of motion，ROM）为（0.1 ± 0.4）°，与术前（7.0 ± 0.6）°比较差异有统计学意义（t=28.500，P=0.004）；Dynesys组手术节段ROM（5.0 ± 1.5）°较术前（7.5 ± 0.8）°减少，但差异无统计学意义（t=0.480，P=0.113）；末次随访时两组间比较差异有统计学意义（t=5.260，P=0.008）。末次随访时Dynesys组邻近节段ROM（7.2 ± 0.7）°较术前（7.3 ± 1.8）°减小，但差异无统计学意义（t=0.510，P=0.108）；PLIF组邻近节段ROM（8.7 ± 0.4）°较术前（7.0 ± 1.6）°明显增加，差异有统计学意义（t=3.440，P=0.042）；末次随访时两组间比较差异有统计学意义（t= —2.100，P=0.047）。结论Dynesys与PLIF治疗腰椎退行性变的近期疗效相当，但Dynesys具有保留手术节段ROM、不增加邻近节段ROM的优势，同时具有促进手术节段椎间盘恢复、预防相邻节段退变的积极作用。

引用本文： 杨兵,江庭彪. 动态中和系统与后路腰椎椎间融合治疗腰椎退行性变的比较研究. 中国修复重建外科杂志, 2013, 27(2): 140-144. doi: 10.7507/1002-1892.20130032 复制

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.	梁春红, 丁亮华, 吴采荣, 等. Dynesys动态稳定系统与腰椎退变性疾病. 国际骨科学杂志, 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.	殷渠东, Jeanneret B. Dynesys 治疗腰椎退变和不稳(附13例报告). 中国矫形外科杂志, 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. 梁春红, 丁亮华, 吴采荣, 等. Dynesys动态稳定系统与腰椎退变性疾病. 国际骨科学杂志, 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. 殷渠东, Jeanneret B. Dynesys 治疗腰椎退变和不稳(附13例报告). 中国矫形外科杂志, 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.

《中国修复重建外科杂志》

动态中和系统与后路腰椎椎间融合治疗腰椎退行性变的比较研究

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《中国修复重建外科杂志》

动态中和系统与后路腰椎椎间融合治疗腰椎退行性变的比较研究

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