动态稳定与融合治疗单节段退行性腰椎滑脱比较

Dynamic stabilization versus instrumented fusion for single-segment degenerative lumbar spondylolisthesis

摘要:

［目的］ 前瞻性对比分析 Dynesys 动态稳定与融合治疗单节段退行性腰椎滑脱的临床疗效。［方法］ 2013 年 1 月— 2016 年 6 月 46 例单节段退行性腰椎滑脱患者随机分为两组，其中，22 例采用 Dynesys 动态稳定（Dynesys 组），24 例采用后路融合固定（PLIF 组）。比较两组围手术期、随访期及影像学资料。［结果］两组患者均顺利完成手术。Dynesys 组手术时间、术中出血量和住院时间均显著优于 PLIF 组 （P<0.05）。所有患者随访 18～40 个月，平均 （25.47±6.69） 个月。末次随访两组的 VAS、ODI 评分均较术前显著降低（P<0.05）。相应时间点，Dynesys 组 VAS 和 ODI 评分均优于 PLIF 组，但差异无统计学意义 （P>0.05）。影像方面，与术前相比，末次随访时两组患者手术节段椎间盘高度、邻近节段椎间盘高度均无显著改变 （P> 0.05）；手术节段 ROM 和腰椎整体 ROM 均显著减小，而邻近节段 ROM 显著增加（P<0.05）。末次随访时，Dynesys 组手术节段和腰椎整体 ROM 显著大于 PLIF 组 （P<0.05），Dynesys 组的邻近节段 UCLA 评级显著优于 PLIF 组 （P<0.05）。［结论］ 动态稳定和融合治疗单节段退行性腰椎滑脱均可取得满意临床疗效，前者能保留更多运动节段活动度，明显降低影像学邻近节段退变发病率，同时具有出血少、创伤小、住院时间短等优点。

Abstract:

[Objective] To prospectively compare the clinical efficacy of Dynesys dynamic stabilization versus intrumented fusion in the treatment of single-segment degenerative lumbar spondylolisthesis. [Methods] From January 2013 to June 2016, a total of 46 patients with single-segment degenerative lumbar spondylolisthesis were randomly divided into two groups. Of them, 22 patients were treated with Dynesys dynamic stabilization (the Dynesys group) , while the other 24 patients were treated with posterior lumbar interbody fusion (the PLIF group) . The perioperative, follow-up and imaging documents were compared between the two groups. [Results] All the patients in both groups had operation completed smoothly. The Dynesys group was significantly superior to the PLIF group in terms of operation time, intraoperative blood loss and hospital stay (P＜0.05) . All patients were followed up for 18-40 months, with a mean of (25.47± 6.69) months. Both VAS and ODI scores in the two groups significantly decreased at the latest follow-up compared with those preoperatively (P＜0.05) . However, at corresponding time points the Dynesys group was slightly superior to the PLIF group in VAS and ODI scores, despite of the fact that no statistically significant differences were noted between them (P＞0.05) . Radiographically, although there were no significant changes in the involved disc height and adjacent disc height (P＞0.05) , the ROMs of affected segment and the whole lumbar spine decreased signifi- cantly, while ROM of the adjacent segment increased significantly at the latest follow-up in both groups compared with those before opera- tion (P＜0.05) . The Dynesys group had significantly greater overall lumbar ROM than the PLIF group at the last interview (P＜0.05) , addi- tionally, the former proved significantly superior to the latter in term of adjacent segment degeneration by using UCLA scale (P＜0.05) . [Conclusion] Both dynamic stabilization and instrumented fusion achieve satisfactory clinical outcomes for treatment of single-segment de- generative lumbar spondylolisthesis. By contrast, the former retains more segment motion, significantly reduce the incidence of radiographic degeneration of adjacent segments, and has the advantages of less bleeding, less trauma and shorter hospital stay.