CAJ | 학술논문

背景：后路腰椎椎体间融合是腰椎退行性疾病经典的治疗方法，目前大量研究表明，融合固定后的相邻节段会发生退变。近年来越来越多的学者关注脊柱的非融合固定技术发展。 　　目的：比较Dynesys动态稳定系统置入内固定和后路腰椎椎体间融合治疗腰椎退行性疾病的临床疗效。 　　方法：对2009年7月至2010年7月收治的56例退行性腰椎间盘疾病患者的临床资料进行回顾性对比分析，其中采用Dynesys动态稳定系统置入内固定治疗28例，采用后路腰椎椎体间融合治疗28例。比较两组患者的手术时间、出血量、治疗后住院时间，应用目测类比评分进行疼痛评估，以Oswestry功能评分评价临床疗效。 　　结果与结论：56例患者均获随访，随访时间18-24个月。两组患者治疗后12个月随访时的Oswestry功能评分、目测类比评分均较治疗前有明显改善(P<0.01)。两组患者手术时间、出血量、治疗后住院天数比较差异有显著性意义(P<0.01)，Dynesys动态稳定系统组优于后路腰椎椎体间融合组。Dynesys动态稳定系统组活动度优于后路腰椎椎体间融合组(P<0.01)。随访期间Dynesys动态稳定系统组未发现钉绳系统和聚脂套管松动。提示与后路腰椎椎体间融合相比，Dynesys 动态稳定系统置入内固定治疗腰椎退行性疾病近期随访具有安全性高、创伤小、可保留固定节段一定活动度的优点，在预防相邻节段椎间盘退变方面有一定的作用。
배경：후로요추추체간융합시요추퇴행성질병경전적치료방법，목전대량연구표명，융합고정후적상린절단회발생퇴변。근년래월래월다적학자관주척주적비융합고정기술발전。 　　목적：비교Dynesys동태은정계통치입내고정화후로요추추체간융합치료요추퇴행성질병적림상료효。 　　방법：대2009년7월지2010년7월수치적56례퇴행성요추간반질병환자적림상자료진행회고성대비분석，기중채용Dynesys동태은정계통치입내고정치료28례，채용후로요추추체간융합치료28례。비교량조환자적수술시간、출혈량、치료후주원시간，응용목측류비평분진행동통평고，이Oswestry공능평분평개림상료효。 　　결과여결론：56례환자균획수방，수방시간18-24개월。량조환자치료후12개월수방시적Oswestry공능평분、목측류비평분균교치료전유명현개선(P<0.01)。량조환자수술시간、출혈량、치료후주원천수비교차이유현저성의의(P<0.01)，Dynesys동태은정계통조우우후로요추추체간융합조。Dynesys동태은정계통조활동도우우후로요추추체간융합조(P<0.01)。수방기간Dynesys동태은정계통조미발현정승계통화취지투관송동。제시여후로요추추체간융합상비，Dynesys 동태은정계통치입내고정치료요추퇴행성질병근기수방구유안전성고、창상소、가보류고정절단일정활동도적우점，재예방상린절단추간반퇴변방면유일정적작용。
BACKGROUND:Posterior lumbar interbody fusion is a typical therapeutic method of lumbar degenerative disease. Present studies suggested that adjacent segment degeneration occurs after fusion. Recently, more and more scholars paid attention to the development of non-fusion of the spine. OBJECTIVE:To compare clinical effects of Dynesys dynamic stabilization system fixation and posterior lumbar interbody fusion in treatment of lumbar degenerative disease. METHODS:From July 2009 to July 2011, clinical data of 56 patients with lumbar degenerative disease were retrospectively analyzed. There were 28 cases of Dynesys dynamic stabilization system fixation, and 28 cases of posterior lumbar interbody fusion. Operation time, bleeding volume, and postoperative hospitalization time were compared in both groups. Visual analog scale was used to assess pain. Oswestry disability index was utilized to evaluate clinical effects. RESULTS AND CONCLUSION:A total of 56 patients were fol owed up for 18-24 months. Visual analog scale and Oswestry disability index scores were significantly improved at 12 months after treatment in both groups (P<0.01). Significant differences in operation time, bleeding volume, and postoperative hospitalization time were detected between both groups (P<0.01). Dynesys dynamic stabilization system group was better than posterior lumbar interbody fusion group. Range of motion was better in the Dynesys dynamic stabilization system group than in the posterior lumbar interbody fusion group (P<0.01). During fol ow-up, nail rope system and polyester sleeve loose were not detectable in the Dynesys dynamic stabilization system group. These results verified that compared with posterior lumbar interbody fusion, Dynesys dynamic stabilization system for lumbar degenerative diseases has a high safety and smal trauma, and can keep advantages of a fixed segment, and exert a certain effect on degeneration of intervertebral disc in the adjacent segment.