【摘要】 目的评估Dynesys内固定系统作为非融合器械治疗腰椎管狭窄症的中长期临床安全性和有效性。方法回顾性分析自2008-06—2011-09行腰椎管开窗减压+椎旁肌入路Dynesys内固定治疗腰椎管狭窄26例,所有患者经非手术治疗无效,且无明显骨质疏松。术后通过疼痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)进行疗效评估,并通过动态侧位X线片评估非融合节段的椎间活动度及椎间隙高度。结果所有患者均获得随访36~66个月,平均45.8个月。术后所有患者症状均不同程度缓解,无切口感染;随访期间均未出现脊髓神经损伤症状加重,无内置物松动、移位、断裂。术后各时间点腰痛VAS评分、ODI指数、椎间活动度、椎间隙高度较术前明显改善,差异有统计学意义(P<0.05)。非融合节段均保留了一定的椎间活动度,活动范围2°~6°,平均4.1°。非融合固定节段椎间隙高度由术前(6.32±0.43)mm恢复为末次随访时(8.55±0.28)mm,邻近节段椎间隙高度未见明显变化。结论 Dynesys内固定系统联合开窗减压治疗腰椎管狭窄症中长期随访疗效满意。更多还原

【Abstract】 Objective To observe and analyze the safety and efficacy of the dynamic stabilization system(Dynesys), as a nonfusion device, in the treatment of lumbar spinal stenosis by medium- and long-term follow-up. Methods From June 2008 to September 2011, a total of 26 cases of lumbar spinal stenosis were treated by the Dynesys system in paraspinal approach and fenestration in the study. The conservative treatment was not effective for all patients and these patients did not have significant osteoporosis. The clinical results were evaluated using the visual analogue scale(VAS) scores and Oswestry disability index(ODI). The disc space height and the range of motion(ROM) in non-fusion segments were evaluated by the dynamic lateral X-rays. Results All 26 patients were followed up for 36 to 66 months, with an average of 45.8 months. All patients after operation had varying degrees of ease of symptoms, and no complications such as implant failures, incision infections were observed. There were significant difference in pre- and post-operative VAS and ODI score(P <0.05). The range ROM of the intervertebral body of non-fusion segments was 2°-6°(average 4.1°). The disc space height of non-fusion segments was from preoperative(6.32 ±0.43)mm to(8.55 ±0.28)mm postoperative(P <0.05). There was no significant difference in disc space height of proximal adjacent segments in non-fusion segments. Conclusion The Dynesys system in paraspinal approach and fenestration has satisfactory medium- and long-term clinical effect in treatment of lumbar spinal stenosis.更多还原