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周兴,郑超,伍骥,黄蓉蓉,吴迪,杜俊杰,张涛,付理强,吴狄,王亮,汪萌.Wiltse入路Dynesys内固定术与TLIF治疗老年腰椎椎管狭窄症的早期疗效对比分析[J].脊柱外科杂志,2017,15(2):82-88.
Wiltse入路Dynesys内固定术与TLIF治疗老年腰椎椎管狭窄症的早期疗效对比分析     点此下载全文 (Fulltext)
周兴  郑超  伍骥  黄蓉蓉  吴迪  杜俊杰  张涛  付理强  吴狄  王亮  汪萌
空军总医院骨科, 北京 100142
基金项目:
DOI:10.3969/j.issn.1672-2957.2017.02.004
摘要点击次数: 184
全文下载次数: 42
摘要:
      目的 评估Wiltse 入路Dynesys 内固定术及Wiltse 入路经椎间孔腰椎椎间融合术(TLIF)治疗老年单节段腰椎椎管狭窄症的临床疗效。方法 回顾性分析2013 年1 月-2015 年1 月本院收治的35 例老年单节段腰椎椎管狭窄患者的临床资料,其中采用Wiltse 入路Dynesys 内固定术15 例(Dynesys 组),Wiltse 入路TLIF 20 例(TLIF 组);随访时间12-18 个月,平均16 个月。比较两组患者围术期指标(手术时间、术中出血量、术后引流量),术前及术后疼痛视觉模拟量表(VAS)评分、Oswestry 功能障碍指数(ODI)、手术节段和邻近节段活动度(ROM)。结果 Dynesys 组手术时间、术中出血量、术后引流量均低于TLIF 组,差异有统计学意义(P< 0.05)。Dynesys 组术后5 d 腰背痛VAS 评分及ODI 均优于TLIF 组,差异有统计学意义(P< 0.05);腿痛VAS 评分两组间差异无统计学意义(P> 0.05)。末次随访时两组患者腰痛和腿痛VAS 评分及ODI 均较术前明显改善,差异有统计学意义(P< 0.05);两组间比较,差异无统计学意义(P> 0.05)。Dynesys 组固定节段ROM较术前减小,TLIF 组固定节段ROM降至0°,与术前相比差异均有统计学意义(P< 0.05)。Dynesys 组上下邻近节段末次随访时的ROM较术前无明显改变,TLIF 组上下邻近节段末次随访时ROM均较术前升高,差异均有统计学意义(P< 0.05);两组间比较,差异有统计学意义(P< 0.05)。结论 Wiltse 入路具有出血量少、手术创伤小、术后恢复快的优点。相较于TLIF,Dynesys 技术不需要支具外固定,允许早期活动,因不需植骨融合而避免了假关节的形成,能够保留固定节段部分ROM,减少邻近节段的过度活动,在治疗老年腰椎椎管狭窄症中具有独特优势。
关键词:老年人  腰椎  椎管狭窄  脊柱融合术  内固定器
Short-term effectiveness of Dynesys stabilization vs. TLIF through Wiltse approaches for treatment of lumbar spinal stenosis in elderly patients    Fulltext
ZHOU Xing  ZHENG Chao  WU Ji  HUANG Rong-rong  WU Di  DU Jun-jie  ZHANG Tao  FU Li-qiang  WU Di  WANG Liang  WANG Meng
Department of Orthopaedics, Air Force General Hospital, Beijing 100142, China
Fund Project:
Abstract:
      Objective To evaluate the short-term effectiveness of Dynesys stabilization and transforaminal lumbar interbody fusion(TLIF) through Wiltse approach for treatment of lumbar spinal stenosis in elderly patients. Methods The clinical data of 35 elderly patients with lumbar spinal stenosis operated in our hospital from January 2013 to January 2015 were retrospectively analyzed. Fifteen patients were treated using Dynesys internal fixation(Dynesys group), and 20 using TLIF through Wiltse approach(TLIF group). The follow-up period was 12-18 months with an average of 16 months. The perioperative indicators (operation time, intraoperative blood loss and volume of drainage), visual analogue scale(VAS) scores, Oswestry disability index(ODI) and the range of motion(ROM) of operative segments and adjacent segments were compared between the 2 groups. Results The operation time, intraoperative blood loss, postoperative drainage volume in Dynesys group were less than those in TLIF group, and the difference was statistically significant(P< 0.05). The VAS score of low back pain and ODI at the postoperative 5 d were lower in Dynesys group than those in TLIF group, and the difference was statistically significant(P< 0.05). The difference in VAS score of leg pain at the postoperative 5 d was not statistically significant between the 2 groups(P> 0.05). At the final follow-up, low back/leg pain VAS scores and ODI significantly improved compared with those at pre-operation in the 2 groups, and the difference was statistically significant(P< 0.05), but there was no significant difference between the 2 groups (P> 0.05). The ROM of stabilized segments in Dynesys group was decreased, and the ROM of TLIF group decreased to 0°; compared with preoperation, the difference was statistically significant(P< 0.05). In Dynesys group, there was no significant change in ROM of the adjacent segment at the final follow-up time, while the ROM in the TLIF group was higher than that of preroperation, the difference was statistically significant(P< 0.05); there was significant difference between 2 groups(P< 0.05). Conclusion The Wiltse approach has advantages of less bleeding, less injury and quick recovery. The Dynesys system does not need support of external fixation, allows the patient to earlyambulate, and can avoid the formation of pseudarthrosis after lumbar interbody fution, remain ROM of the operation segment, and limit hypermobility of the adjacent segment, thus being of unique advantages in the treatment of lumbar spinal stenosis in elderly patients.
Keywords:Aged  Lumbar vertebrae  Spinal Stenosis  Spinal fusion  Internal fixators
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