经关节突减压融合联合Dynesys动态稳定系统治疗腰椎退行性病变患者的效果

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摘要目的探究并分析经关节突减压融合联合Dynesys动态稳定系统治疗腰椎退行性病变患者的效果。方法选取2014年8月～2015年8月河北北方学院附属第一医院收治的腰椎退行性病变患者100例作为研究对象，按照随机数字表法将其分为对照组及观察组，每组各50例。对照组采用经关节突减压融合治疗，观察组采用经关节突减压融合联合Dynesys动态稳定系统治疗，比较两组患者术前及术后1、12个月和24个月腰椎整体活动度、手术节段活动度、邻近上一椎间活动度、邻近上一椎间高度和腰椎功能评分（ODI）。结果术前两组整体腰椎活动度比较，差异无统计学意义（P ＞ 0.05）；术后1、12个月和24个月两组腰椎活动度均明显低于术前；术后随着时间的延长，两组腰椎整体活动度均明显增加，但观察组腰椎整体活动度增加幅度明显高于对照组，差异均有统计学意义（P ＜ 0.05）。术前两组手术节段活动度比较，差异无统计学意义（P ＞ 0.05），术后1、12个月和24个月两组手术节段活动度均明显低于术前；术后随着时间的延长，两组手术节段活动度增加幅度均明显高于术前，且观察组增加幅度均明显高于对照组，差异均有统计学意义（P ＜ 0.05）。术前两组患者上一椎间活动度比较，差异无统计学意义（P ＞ 0.05）；术后两组上一椎间活动度均高于术前，差异均有统计学意义（P ＜ 0.05）；术后随着时间的延长，两组患者上一椎间活动度均明显增加，且对照组增加幅度明显高于观察组，差异均有统计学意义（P ＜ 0.05）。术前、术后1、12个月和24个月两组上一椎间高度比较，差异均无统计学意义（P ＞ 0.05）。术前两组ODI评分比较，差异无统计学意义（P ＞ 0.05），随着术后时间的延长，两组患者ODI评分均明显低于术前，且术后1个月和术后12个月观察组明显低于对照组，差异均有统计学意义（P ＜ 0.05）。结论经关节突减压联合Dynesys动态稳定系统能有效增加腰椎退行性病变患者的腰椎活动度，减轻术后疼痛程度，改善治疗效果，值得临床推广应用。

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	杜鑫冲1 王军1 李化光1 王燕波1 杨毅鹏2 张培楠1

关键词 ：腰椎退行性变, 疼痛, 腰椎活动度, Dynesys动态稳定系统

Abstract：Objective To explore and analyze the effect of transarticular decompression fusion combined with Dynesys dynamic stabilization system in the treatment of patients with lumbar degenerative disease. Methods From August 2014 to August 2015, 100 patients with lumbar degenerative disease admitted to the First Affiliated Hospital of Hebei North University were selected as the research subjects and divided into the control group and the observation group by the random number table, with 50 cases in each group. The control group treated with transarticular decompression treatment, while the observation group treated with transarticular decompression fusion combined with Dynesys dynamic stabilization system. The overall lumbar activity, lumbar segment activity, adjacent intervertebral activities, adjacent intervertebral height and lumbar function score (ODI) were compared preoperative, posteoperative of 1, 12 month and 24 month between the two groups. Results Before operation, there was no statistically signicant difference in the overall lumbar activity between the two groups (P ＞ 0.05); after operation of 1, 12 month and 24 month, the overall lumbar activity in the two groups were all lower than those of before operation; and with the extension of time, the overall lumbar activity in the two groups were all increased, and the indicator in the observation group increased much more significantly than that of control group, with statistically signicant difference (P ＞ 0.05). Before operation, there was no statistically signicant difference in the lumber segment activity between the two groups (P ＞ 0.05); after operation of 1, 12 month and 24 month, the lumber segment activity in the two groups were all lower than those of before operation; and with the extension of time, the lumber segment activity in the two groups were all increased, and the indicator in the control group increased much more significantly than that of observation group, with statistically signicant difference (P < 0.05). Before operation, there was no statistically signicant difference in the adjacent intervertebral activities between the two groups (P ＞ 0.05); after operation of 1, 12 month and 24 month, the adjacent intervertebral activities in the two groups were all higher than those of before operation; and with the extension of time, the adjacent intervertebral activities in the two groups were all increased, and the indicator in the observation group increased much more significantly than that of control group, with statistically signicant difference (P ＞ 0.05). There was no statistically signicant difference in the adjacent intervertebral height between the two groups before and after operation of 1, 12 month and 24 month (P ＞ 0.05). Before operation, there was no statistically signicant difference in the score of ODI between the two groups (P ＞ 0.05), after operation of 1, 12 month and 24 month, the scores of ODI were all lower than those of before operation; and the scores of 1 month and 12 month in the observation group decreased much more significantly than that of control group, with statistically signicant difference (P ＜ 0.05). Conclusion Transarticular decompression fusion combined with Dynesys dynamic stabilization system can effectively increase the lumbar range of motion in patients with lumbar degenerative disease, relieve the postoperative pain and improve the clinical efficacy of patients. It is worthy of clicical promotion and application.

Key words： Lumbar degenerative changes Pain lumbar motion degree Dynesys dynamic stabilization system

基金资助:河北省医学科学研究重点课题（20160353）。

引用本文:

杜鑫冲1 王军1 李化光1 王燕波1 杨毅鹏2 张培楠1. 经关节突减压融合联合Dynesys动态稳定系统治疗腰椎退行性病变患者的效果[J]. 中国医药导报, 2018, 15(9): 53-56.
DU Xinchong1 WANG Jun1 LI Huaguang1 WANG Yanbo1 YANG Yipeng2 ZhANG Peinan1. Effect of transarticular decompression fusion combined with Dynesys dynamic stabilization system in the treatment of patients with lumbar degenerative disease. 中国医药导报, 2018, 15(9): 53-56.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2018/V15/I9/53

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