CAJ | 학술논문

目的：比较单纯髓核摘除术与髓核摘除联合动态稳定系统( dynamic neutralization system， Dynesys )治疗腰椎间盘突出症的临床疗效，评价两种术式对术后腰椎活动度的影响。方法回顾性分析2009年5月至2011年1月，我院采用单纯髓核摘除术与髓核摘除联合 Dynesys 治疗并获得3年以上随访的 L4～5椎间盘突出症患者61例，男36例，女25例；年龄29～61(平均40.5)岁；其中单纯髓核摘除组29例，髓核摘除联合 Dynesys 动态固定组32例。手术前后行视觉模拟评分( visual analogue scale，VAS )、Oswestry 功能障碍指数( oswestry disability index，ODI )评分及手术节段椎间高度、活动度( range of motion，ROM )、相邻节段椎间高度及 ROM 测定。结果61例均获得随访，随访时间36～41(平均39.1)个月。单纯髓核摘除组与髓核摘除联合 Dynesys 组患者术后及末次随访 VAS、ODI 评分较术前降低(P＜0.05)，Dynesys 组患者末次随访 VAS 及 ODI 评分改善率高于单纯髓核摘除组，差异有统计学意义(P＜0.05)。Dynesys 组术后手术节段椎间隙高度较术前增大，差异有统计学意义(P＜0.05)，术后手术节段 ROM 较术前减小(P＜0.05)。单纯髓核摘除组末次随访时手术节段椎间隙高度较术前明显减小(P＜0.05)，术后手术节段 ROM 与术前比较无显著变化(P＞0.05)。单纯髓核摘除组与髓核摘除联合 Dynesys 组术后上下邻近节段椎间隙高度及 ROM 较术前无明显变化(P＞0.05)。术后 Dynesys 组手术节段 ROM 小于单纯髓核摘除组，差异有统计学意义(P＜0.05)，但末次随访时 Dynesys 组手术节段椎间隙高度明显大于单纯髓核摘除组(P＜0.05)。术后 Dynesys 组上下邻近节段椎间隙高度及椎间活动度与单纯髓核摘除组比较，差异无统计学意义(P＞0.05)。结论两种术式治疗腰椎间盘突出症临床疗效确切，髓核摘除联合 Dynesys 在保留手术节段部分活动性的同时对邻近节段无显著影响。目的：比較單純髓覈摘除術與髓覈摘除聯閤動態穩定繫統( dynamic neutralization system， Dynesys )治療腰椎間盤突齣癥的臨床療效，評價兩種術式對術後腰椎活動度的影響。方法迴顧性分析2009年5月至2011年1月，我院採用單純髓覈摘除術與髓覈摘除聯閤 Dynesys 治療併穫得3年以上隨訪的 L4～5椎間盤突齣癥患者61例，男36例，女25例；年齡29～61(平均40.5)歲；其中單純髓覈摘除組29例，髓覈摘除聯閤 Dynesys 動態固定組32例。手術前後行視覺模擬評分( visual analogue scale，VAS )、Oswestry 功能障礙指數( oswestry disability index，ODI )評分及手術節段椎間高度、活動度( range of motion，ROM )、相鄰節段椎間高度及 ROM 測定。結果61例均穫得隨訪，隨訪時間36～41(平均39.1)箇月。單純髓覈摘除組與髓覈摘除聯閤 Dynesys 組患者術後及末次隨訪 VAS、ODI 評分較術前降低(P＜0.05)，Dynesys 組患者末次隨訪 VAS 及 ODI 評分改善率高于單純髓覈摘除組，差異有統計學意義(P＜0.05)。Dynesys 組術後手術節段椎間隙高度較術前增大，差異有統計學意義(P＜0.05)，術後手術節段 ROM 較術前減小(P＜0.05)。單純髓覈摘除組末次隨訪時手術節段椎間隙高度較術前明顯減小(P＜0.05)，術後手術節段 ROM 與術前比較無顯著變化(P＞0.05)。單純髓覈摘除組與髓覈摘除聯閤 Dynesys 組術後上下鄰近節段椎間隙高度及 ROM 較術前無明顯變化(P＞0.05)。術後 Dynesys 組手術節段 ROM 小于單純髓覈摘除組，差異有統計學意義(P＜0.05)，但末次隨訪時 Dynesys 組手術節段椎間隙高度明顯大于單純髓覈摘除組(P＜0.05)。術後 Dynesys 組上下鄰近節段椎間隙高度及椎間活動度與單純髓覈摘除組比較，差異無統計學意義(P＞0.05)。結論兩種術式治療腰椎間盤突齣癥臨床療效確切，髓覈摘除聯閤 Dynesys 在保留手術節段部分活動性的同時對鄰近節段無顯著影響。
목적：비교단순수핵적제술여수핵적제연합동태은정계통( dynamic neutralization system， Dynesys )치료요추간반돌출증적림상료효，평개량충술식대술후요추활동도적영향。방법회고성분석2009년5월지2011년1월，아원채용단순수핵적제술여수핵적제연합 Dynesys 치료병획득3년이상수방적 L4～5추간반돌출증환자61례，남36례，녀25례；년령29～61(평균40.5)세；기중단순수핵적제조29례，수핵적제연합 Dynesys 동태고정조32례。수술전후행시각모의평분( visual analogue scale，VAS )、Oswestry 공능장애지수( oswestry disability index，ODI )평분급수술절단추간고도、활동도( range of motion，ROM )、상린절단추간고도급 ROM 측정。결과61례균획득수방，수방시간36～41(평균39.1)개월。단순수핵적제조여수핵적제연합 Dynesys 조환자술후급말차수방 VAS、ODI 평분교술전강저(P＜0.05)，Dynesys 조환자말차수방 VAS 급 ODI 평분개선솔고우단순수핵적제조，차이유통계학의의(P＜0.05)。Dynesys 조술후수술절단추간극고도교술전증대，차이유통계학의의(P＜0.05)，술후수술절단 ROM 교술전감소(P＜0.05)。단순수핵적제조말차수방시수술절단추간극고도교술전명현감소(P＜0.05)，술후수술절단 ROM 여술전비교무현저변화(P＞0.05)。단순수핵적제조여수핵적제연합 Dynesys 조술후상하린근절단추간극고도급 ROM 교술전무명현변화(P＞0.05)。술후 Dynesys 조수술절단 ROM 소우단순수핵적제조，차이유통계학의의(P＜0.05)，단말차수방시 Dynesys 조수술절단추간극고도명현대우단순수핵적제조(P＜0.05)。술후 Dynesys 조상하린근절단추간극고도급추간활동도여단순수핵적제조비교，차이무통계학의의(P＞0.05)。결론량충술식치료요추간반돌출증림상료효학절，수핵적제연합 Dynesys 재보류수술절단부분활동성적동시대린근절단무현저영향。
Objective To compare clinical efifcacy of discectomy and discectomy plus dynamic neutralization system ( Dynesys ) in the treatment of lumbar disc herniation, and assess the effects of two kinds of operations on postoperative lumbar activity.Methods Sixty-one patients ( 36 males and 25 females ) with L4-5 disc herniation were treated by discectomy or discectomy plus Dynesys from May 2009 to January 2011, with more than 3 years’ follow-up. The average age was 40.5 years old ( range: 29-61 years ). Thirty-two cases were treated with discectomy plus Dynesys, and 29 cases were treated with discectomy. Clinical outcomes were evaluated by preoperative and postoperative visual analogue scales ( VAS ), and Oswestry disability index ( ODI ). Intervertebral space, range of motion ( ROM ) of the surgical segments and adjacent segment were measured as well.Results A total of 61 patients completed the ifnal follow-up. The mean duration of follow-up was 39.1 months ( range: 36-41 months ). The scores of VAS and ODI decreased signiifcantly after surgery and at the ifnal follow-up (P<0.05 ). The improvement rate of VAS and ODI in the group of discectomy plus Dynesys was higher than that of discectomy group, with statistical signiifcance (P<0.05 ). The intervertebral space was signiifcant increased in the group of discectomy plus Dynesys after surgery with statistical signiifcance (P<0.05 ), and surgical segment ROM was signiifcant decreased after surgery (P<0.05 ). The intervertebral space was significant decreased in the group of discectomy at the final follow-up (P<0.05 ), but surgical segment ROM had no signiifcant changes after surgery (P>0.05 ). There were no signiifcant changes at the adjacent segments in both group (P>0.05 ). The postoperative surgical segment ROM in discectomyplus Dynesys was less than discectomy with statistical significance (P<0.05 ). The postoperative intervertebral space in discectomy plus Dynesys was greater than discectomy with statistical signiifcance (P<0.05 ). No statistical signiifcance existed in the intervertebral space and ROM of surgical and adjacent segments ( P>0.05 ).Conclusions Both discectomy and discectomy plus Dynesys are apparently effective in the treatment of lumbar disc herniation. Discectomy plus Dynesys can keep the surgical segment ROM and stability without obvious inlfuence on adjacent segments.