CAJ | 학술논문

目的：对Dynesys动态稳定系统治疗术后的单节段与双节段患者的短期疗效进行对比。方法选取2009年7月至2012年3月采用Dynesys动态固定系统结合后路椎板减压治疗的40例腰椎退变性疾病的患者，根据腰腿疼痛视觉模拟评分（VAS）、功能障碍指数（ODI）评分和北美骨科脊柱协会（NASS）指数评估临床疗效，同时行影像学观察手术节段与近侧邻近节段椎间活动度、椎间隙高度的退行性改变。结果40例患者全部获得随访，术后3个月及末次随访的VAS、ODI评分与术前相比有明显下降（P＜0．05）；单节段组与双节段组术后与末次随访时的VAS、ODI评分比较，差异无统计学意义（P＞0．05）。NASS指数显示术后两组患者对疗效的满意度比较，差异无统计学意义（P＞0．05），两组患者椎间隙高度术前与末次随访改变量差异无统计学意义（P＞0．05）。近侧邻近节段活动度末次随访时，两组患者比较差异有统计学意义（P＜0．05），但是末次随访与术前相比，仅单节段组的邻近节段活动度差异有统计学意义（P＜0．05）。结论Dynesys动态中和固定系统结合椎板减压手术治疗腰椎退变性疾病有较好的临床效果，但单节段较双节段对近侧邻近节段活动度增加的影响更为显著。
목적：대Dynesys동태은정계통치료술후적단절단여쌍절단환자적단기료효진행대비。방법선취2009년7월지2012년3월채용Dynesys동태고정계통결합후로추판감압치료적40례요추퇴변성질병적환자，근거요퇴동통시각모의평분（VAS）、공능장애지수（ODI）평분화북미골과척주협회（NASS）지수평고림상료효，동시행영상학관찰수술절단여근측린근절단추간활동도、추간극고도적퇴행성개변。결과40례환자전부획득수방，술후3개월급말차수방적VAS、ODI평분여술전상비유명현하강（P＜0．05）；단절단조여쌍절단조술후여말차수방시적VAS、ODI평분비교，차이무통계학의의（P＞0．05）。NASS지수현시술후량조환자대료효적만의도비교，차이무통계학의의（P＞0．05），량조환자추간극고도술전여말차수방개변량차이무통계학의의（P＞0．05）。근측린근절단활동도말차수방시，량조환자비교차이유통계학의의（P＜0．05），단시말차수방여술전상비，부단절단조적린근절단활동도차이유통계학의의（P＜0．05）。결론Dynesys동태중화고정계통결합추판감압수술치료요추퇴변성질병유교호적림상효과，단단절단교쌍절단대근측린근절단활동도증가적영향경위현저。
Objective To compare the short‐term clinical effects of single segment and two segments of Dynesys dynamic in‐ternal fixation system for treating lumbar degenerative disease .Methods 40 cases of degenerative lumbar disease treated by the Dynesys dynamic fixation system combined with posterior approach decompression from 2009 July to March 2012 were selected and performed the evaluation on the clinical effects by the waist and leg pain visual analogue scale (VAS) ,the Oswestry disability index (ODI) and the orthopaedic spinal association of North America (NASS) index .The imaging method was used to observe the mobili‐ty of operative segment and proximal adjacent segment and the degenerative change of intervertebral height .Results All of the 40 cases were followed up .The VAS score and ODI score at postoperative 3 months and last follow‐up were significantly decreased when compared with the pre‐operative scores (P<0 .05);there was no statistically significant differences in the VAS score and ODI score at 3 months and last follow‐up between the single segment group and the 2‐segment group (P> 0 .05) .The NASS index showed no statistically significant difference in the postoperative effect satisfaction between the two groups (P>0 .05);there was no statistically significant difference in the variation of the intervertebral height between before operation and at the last follow‐up (P>0 .05) .There was statistically significant difference in the motility of proximal adjacent segment at the last follow‐up between the two groups (P<0 .05);but comparing the motility of proximal adjacent segment between the last follow‐up and pre‐operation , only the single segment group showed statistically significant difference (P< 0 .05) .Conclusion The Dynesys dynamic fixation system combined with posterior approach decompression operation has good clinical effect in the treatment of lumbar degenerative disease .Meanwhile ,the single segment method has more significant effect on the motility of proximal adjacent segment than the double segments method .