Dynesys治疗腰椎退变及不稳.docVIP

Dynesys治疗腰椎退变及不稳 　【摘要】 探讨动力性固定器Dynesys治疗腰椎退变和不稳的固定原理、适应证和初步疗效。［方法］作者于2004年在瑞士Basel大学骨科进修学习期间，随访Dynesys治疗12个月以上的13例患者，平均随访16个月（范围12～25个月）；年龄58～78岁，平均65岁；所有患者均有保守治疗难以治愈的腰痛或腰腿痛6个月以上，术前Oswestry评分50～69分，平均58分；Ⅰ度退变性腰椎滑脱1例，腰椎管狭窄症6例，腰椎间盘突出症或伴节段性不稳3例，退变性脊椎关节病3例。［结果］Oswestry评分至最后随访改善到24～53分，平均31.3分；参照Nakai标准，优5例，良5例，可2例，差1例；无螺钉弯曲或断裂。差者1例术后1年再次行椎管探查、改行强直性固定融合。［结论］Dynesys是治疗腰椎退变和轻度不稳的一种有效的非融合性、动力性固定系统。 【关键词】 腰椎 动力性固定 Dynesys Abstract：［Objective］To study the stabilization mechanism,indications and primary treatment results of dynamic stabilization systemDynesys.［Method］Thirteen cases were followed up for a minimum of 12 months with an average of 16 months（ranged,12～25 months）.The mean age was 57～73 years with an average of 68.All the patients had got lowback pain and/or leg pain resistant to conservative treatments lasting over 6 months.Oswestry scores were 50～73 with an average of 60.2 preoperatively.The pathologies treated were degenerative spondylolisthesis in 1 case,spinal stenosis in 6 cases,disc herniation or accompanied by segmental instability in 3 cases,osteochondrosis and facet joint osteoarthritis in 3 cases.［Result］The Oswestry scores were 24～53 with an average of 31.3 at the final follow up.According to Nakais criteria,excellent and good in five,passable in two and poor in one were found.There was no bending of broken of screws.One case for poor was reoperated one year later,in whom Dynesys was replaced by rigid stabilization and grafting.［Conclusion］Dynesys is an effective nonfusion and dynamic stabilization system for degeneration and light instability of lumbar. Key words：lumbar; dynamic stabilization; Dynesys Dynesys是一种新的治疗腰椎退变和不稳的非融合性、动力性固定器，称为动态中和固定系统（dynamic neutralization system，简称Dynesys）〔1、2〕，可维持或恢复腰椎节段间正常运动和矢状面对线，而且对临近节段无不利影响，近年逐渐受到提倡，尤其在欧洲应用较为普遍，国内未见应用报道。本文报道13例Dynesys治疗结果，并讨论其固定原理和适应证。 1 临床资料和手术方法 1.1 一般资料 作者于2004年在瑞士Basel大学骨科进修学习期间，参加了30余例Dynesys手术。该院于2001年开始应用Dynesys固定，现已超过300例。本组为学习期间随访12个月以上的13例患者；年龄58～78岁，平均65岁。所有患者均有腰痛或腰腿痛持续6个月以上，而且对保守治