椎管减压Dynesys动态固定治疗多节段腰椎管狭窄症的中期临床疗效
Midterm clinical effects of decompression and Dynesys dynamic stabilization in treating multi-segmental lumbar spinal stenosis
罗磊 1刘列华 1赵晨 1李培 1周强 1梁利川 1高永建1
作者信息
- 1. 重庆医科大学附属第三医院脊柱外科 401120重庆市
- 折叠
摘要
目的:评估椎管减压Dynesys动态固定治疗多节段腰椎管狭窄症的中期临床疗效.方法:回顾性分析2010年3月～2015年6月在我院接受椎管减压以及3节段以上Dynesys动态固定手术治疗的59例腰椎管狭窄症患者的临床资料,其中男性28例,女性31例,年龄67.6±8.9岁(49～80岁).统计患者手术时间、失血量、手术并发症情况;术前、术后3个月及末次随访时进行疼痛视觉模拟量表(visual analog scale,VAS)评分评价腰腿痛情况,采用Oswestry功能障碍指数(Oswestry disability index,ODI)评价腰椎功能情况,同时行腰椎X线检查并评估腰椎前凸角、固定节段活动度及上端邻近节段活动度,计算固定节段活动度保留百分比.结果:3节段Dynesys动态固定44例,4节段13例,5节段2例.手术时间259±58min,失血量593±296mL,随访7.2±1.3年(5～9年).患者术后3个月VAS腰腿痛评分以及ODI明显下降,与术前相比差异具有统计学意义(P＜0.05).末次随访时,4例患者出现螺钉(6枚)松动,但无腰痛症状;1例患者术后34个月发生深部感染,经穿刺排脓、灌洗以及静脉使用抗生素4周后治愈;无翻修手术病例.末次随访时,固定节段活动度为13.1°±4.7°,较术前(28.9°±8.1°)平均保留了 43.8％的活动度;上端邻近节段活动度及腰椎前凸角与术前相比差异无统计学意义(P＞0.05).结论:椎管减压Dynesys动态固定治疗多节段腰椎管狭窄症是一种安全、有效的方法,且创伤较小,术后腰椎活动功能较好.
Abstract
Objectives:To assess the midterm clinical outcomes after decompression and dynamic stabiliza-tion(Dynesys system)in multi-segmental lumbar spinal stenosis.Methods:The clinical data of 59 patients with lumbar spinal stenosis treatedwith decompression and 3 or more segments dynamic stabilization in our hospital from March 2010 to June 2015 were retrospectively reviewed.There were 28 males and 31 females,with an average age of 67.6±8.9 years(49-80 years).The operative time,blood loss and complications of the patients were collected.Before operation,at 3 months after surgery and final follow-up,visual analog scale(VAS)was used to assess the pain status of low back and leg,and Oswestry disability index(ODD was adopt-ed for functional evaluation,and also lumbar lordosis,range of motions(ROMs)of fixed segments and the first upper adjacent segment were evaluated with X-ray examination in the mean time,and the retention of ROM of the fixed segments was also calculated.Results:3 segmental Dynesys dynamic stabilizations were per-formed in 44 patients,4 segmental dynamic stabilizations were in 13 paticnts,5 segmental stabilizations were in 2 patients.The operative time was 259±58min,and the average blood loss was 593±296mL.The mean follow-up period was 7.2±1.3 years(range 5-9 years).The VAS scores and ODI at 3 months after operation improved significantly compared with those preoperatively(P＜0.05).At final follow-up,loosening was observed in 6 screws in 4 patients,who were asymptomatic;Wound infection developed in 1 patient at 34 months after surgery,which was cured by puncture pumping pus,irrigation and antibiotics for 4 weeks;None of the patients underwent revision surgery.At final follow-up,the ROM of the fixed segments was 13.1°±4.7°,which on average retained 43.8％of the preoperative ROM(28.9°±8.1°),and the ROM of the adjacent upper segement,and lumbar lordosis were preserved compared with before operation with no statistical difference(P＞0.05).Conclusions:Decompression and dynamic stabilization with Dynesys system was a safe and effective treatment in patients with multi-segmental lumbar spinal stenosis,which preserves lumbar activities with minor injury.
关键词
腰椎管狭窄症/多节段/动态固定/疗效/并发症Key words
Lumbar spinal stenosis/Multiple segments/Dynamic stabilization/Efficacy/Complications引用本文复制引用
基金项目
重庆市科卫联合医学科研项目青年项目(2022QNXM022)
重庆市科卫联合医学科研面上项目(2024MSXM030)
出版年
2024
NETL
NSTL
万方数据