CAJ | 학술논문

目的：探讨经椎弓根Dynesys动态固定治疗腰椎退变性疾病的临床疗效。方法回顾性分析34例采用经椎弓根Dynesys 动态固定治疗腰椎退变性疾病患者的临床资料，腰痛视觉模拟量表评分（VAS）为（6．01±0．98）分，腿痛 VAS为（5．47±0．63）分，功能障碍指数（ODI）为（64．47±2．06）％，固定节段头侧椎间隙高度为（12．01±1．08）mm ，固定节段椎间隙高度为（11．47±1．13）mm，固定节段尾侧椎间隙高度为（11．95±1．06）mm ；固定节段头侧节段椎间活动度（ROM）为（8．11±1．21）°，固定节段 ROM为（8．47±1．63）°，固定节段尾侧节段 ROM为（7．86±1．36）°。27例39个椎间隙采用减压结合 Dynesys固定，7例单间隙行单纯Dynesys固定。结果所有患者平稳渡过围术期，未出现伤口感染、脑脊液漏、神经损伤等并发症，并获得25～45个月随访，平均31．2个月，末次随访时腰痛 VAS为（1．85±1．03）分，腿痛 VAS为（1．54±0．18）分，ODI为（11．42±1．51）％，固定节段头侧椎间隙高度为（11．85±0．93）mm，固定节段椎间隙高度为（11．34±1．02）mm，固定节段尾侧椎间隙高度为（11．62±0．97）mm；固定节段头侧节段 ROM为（8．85±1．33）°，固定节段 ROM为（4．54±1．78）°，固定节段尾侧节段 ROM为（7．62±1．21）°。结论经椎弓根Dynesys 动态固定治疗腰椎退变性疾病，能够限制保留固定节段活动度、缓解腰腿痛、改善腰腿功能，对相邻节段无明显影响，短期疗效满意，其长期疗效需长时间、大宗病例的临床观察。
목적：탐토경추궁근Dynesys동태고정치료요추퇴변성질병적림상료효。방법회고성분석34례채용경추궁근Dynesys 동태고정치료요추퇴변성질병환자적림상자료，요통시각모의량표평분（VAS）위（6．01±0．98）분，퇴통 VAS위（5．47±0．63）분，공능장애지수（ODI）위（64．47±2．06）％，고정절단두측추간극고도위（12．01±1．08）mm ，고정절단추간극고도위（11．47±1．13）mm，고정절단미측추간극고도위（11．95±1．06）mm ；고정절단두측절단추간활동도（ROM）위（8．11±1．21）°，고정절단 ROM위（8．47±1．63）°，고정절단미측절단 ROM위（7．86±1．36）°。27례39개추간극채용감압결합 Dynesys고정，7례단간극행단순Dynesys고정。결과소유환자평은도과위술기，미출현상구감염、뇌척액루、신경손상등병발증，병획득25～45개월수방，평균31．2개월，말차수방시요통 VAS위（1．85±1．03）분，퇴통 VAS위（1．54±0．18）분，ODI위（11．42±1．51）％，고정절단두측추간극고도위（11．85±0．93）mm，고정절단추간극고도위（11．34±1．02）mm，고정절단미측추간극고도위（11．62±0．97）mm；고정절단두측절단 ROM위（8．85±1．33）°，고정절단 ROM위（4．54±1．78）°，고정절단미측절단 ROM위（7．62±1．21）°。결론경추궁근Dynesys 동태고정치료요추퇴변성질병，능구한제보류고정절단활동도、완해요퇴통、개선요퇴공능，대상린절단무명현영향，단기료효만의，기장기료효수장시간、대종병례적림상관찰。
Objective To summarize the clinical effect of transpedicular Dynesys dynamic fixation for treating degenerative lum-bar disease.Methods 34 cases of degenerative lumbar disease were treated by transpedicular Dynesys dynamic fixation and per-formed the retrospective analysis.The VAS score of lumbago was (6.01±0.98),the VAS score of skelalgia was (5.47±0.63), ODI was(64.47 ±2.06)%.The cranial intervertebral space height in the fixed segment was(12.01±1.08)mm,the intervertebral space height in the fixed segment was(11.47±1.13)mm;the caudal intervertebral space height in the fixed segment was(11.95± 1.06)mm;the intervertebral motion range of the cranial segment in the fixed segment was(8.11±1.21)°,the intervertebral motion range of the fixed segment was(8.47±1.63)°,the intervertebral motion range of the caudal segment in the fixed segment(7.86± 1.36)°.39 intervertebral spaces in 27 cases adopted the decompression combined with Dynesys fixation,the single intervertebral space in 7 cases was performed with Dynesys fixation alone.Results All patients smoothly pulled through the perioperative period. No complications of wound infection,leakage of cerebralspinal fluid and nerve inj ury occurred,wound infection,leakage of cerebro-spinal fluid and nerve injury.All patients were followed up for 25-45 months,averaged 31.2 months.The VAS score of lumbago at the last time of follow up was (1.85±1.03),the VAS score of skelalgia was(1.54±0.18),ODI was(11.42±1.51)%,the cranial intervertebral space height in the fixed segment was(11.85±0.93)mm,the intervertebral space height of the fixed segment was (11.34±1.02)mm,the caudal intervertebral space height in the fixed segment was(11.62±0.97)mm;the intervertebral space motion range of the cranial segment in the fixed segment was(8.85 ± 1.33)°,the intervertebral space motion range of thye fixed segment was(4.54±1.78)°,the intervertebral space motion range of the caudal segment in the fixed segment was(7.62±1.21)°. Conclusion Transpedicular Dynesys dynamic fixation for treating degenerative lumbar disease can confine and reserve the motion range of the fixed segment,lessen lumbago and skelalgia,improve the function of waist and leg and have no obvious influence on the adjacent segment,its short-term therapeutic effect is satisfactory,but long-term therapeutic effect needs the clinical observation of long time and large amount cases.