中国组织工程研究 ›› 2019, Vol. 23 ›› Issue (24): 3895-3900.doi: 10.3969/j.issn.2095-4344.1267

• 骨与关节综述 bone and joint review • 上一篇    下一篇

Dynesys动态内固定治疗腰椎退行性疾病生物力学特点与邻近节段退变的关系

黄道余
  

  1. 南京医科大学第二附属医院骨科,江苏省南京市  210000
  • 出版日期:2019-08-28 发布日期:2019-08-28
  • 作者简介:黄道余,男,1992年生,安徽省六安市人,汉族,2018年解放军总医院第七医学中心毕业,硕士,医师,主要从事脊柱外科疾病研究。

Dynesys dynamic internal fixation for treating lumbar degenerative diseases: relationship between biomechanical characteristics and adjacent segment degeneration

Huang Daoyu
  

  1. Department of Orthopedics, the Second Affiliated Hospital of Nanjing Medical University, Nanjing 210000, Jiangsu Province, China
  • Online:2019-08-28 Published:2019-08-28
  • About author:Huang Daoyu, Master, Physician, Department of Orthopedics, the Second Affiliated Hospital of Nanjing Medical University, Nanjing 210000, Jiangsu Province, China

摘要:

文章快速阅读:
 
 
 
文题释义:
Dynesys:即Dynamic Neutralization System,中文称为动态中和稳定系统,是一种应用于腰椎手术的动态内固定装置,相比以往的钛棒坚强固定而言,Dynesys动态稳定系统可在稳定手术节段基础上保留手术节段的部分活动度,尽可能对腰椎生理活动予以保留,从而达到预防邻近节段退变的初衷。有关Dynesys术后是够能达到这一初衷,大量学者做了大量研究,此文给予综述。
退行性病:为伴随年龄的增长人体的组织、器官所发生的一种“老化”。除外年龄,身体负荷过重,将会加速组织器官的衰老退化,腰椎是人体最容易发生退行性变的部位之一,早期症状轻微,之后日积月累,最终发展成骨刺、椎间盘突出等,就会出现腰痛伴或不伴下肢疼痛不适等症状。腰椎间盘突出伴随的症状一般是腰、背、下肢疼痛。
 
摘要
背景:近年来,随着腰椎内固定技术的不段革新,Dynesys内固定成为继腰椎融合术之后治疗腰椎退变疾病的新方法,也是目前临床最普遍的非融合术式之一。Dynesys动态内固定系统旨在维持脊柱稳定性并保持手术节段的部分活动性,现如今Dynesys这一固定手段术后对于邻近节段的影响仍未可知。
目的:回顾Dynesys治疗腰椎退行性疾病的现状和临床治疗方法。
方法:通过PubMed搜索2002至2018年出版的文献,检索关键词为“lumbar degenerative disease,treatment/therapy,dynesys dynamic stabilization system/Dynesys”。对检索所得文献进行摘要阅读后记录其术后腰椎生物力学、临床疗效、邻近节段退变程度等内容。
结果与结论:①作为最常用的非融合技术,Dynesys动态稳定系统可以实现与融合相似的临床效果;②大量研究均表明,Dynesys内固定可维持脊柱稳定,保留病椎节段部分活动,降低关节突关节负荷及椎间盘内压力;③长远来看,Dynesys内固定术后出现螺钉松动、腰椎前凸纠正不良等并发症较为常见,如何预防并发症的发生仍需要更深层次的探索研究;④此外,坚强固定术后邻近节段发生退变是自然发展过程还是内固定的作用仍存在争议,需要长期大样本的随访研究,以明确其发生机制。

关键词: 动态稳定系统, Dynesys, 腰椎, 非融合, 退行性疾病, 内固定, 生物力学, 邻近节段退变

Abstract:

BACKGROUND: With the innovation on the internal fixation technique of lumbar vertebrae, the Dynesys system is another choice for treating degenerative diseases of lumbar spine. It is one of the most common non-fusion techniques in clinical application. Dynesys dynamic internal fixation system is to maintain the stability of the spine, to retain the physiological activity of the fixed segment, and prevent the adjacent segment degeneration, but its effect on the adjacent segment is still unknown.
OBJECTIVE: To analyze the research status and clinical treatments of the lumbar degenerative diseases in Dynesys internal fixation.
METHODS: PubMed database was retrieved using the keywords of “lumbar degenerative disease, treatment/therapy, Dynesys dynamic stabilization system/Dynesys” for the articles published between 2002 and 2018. The biomechanics, clinical efficacy and adjacent segment degeneration of the lumbar spine were recorded after reading the retrieved literature.
RESULTS AND CONCLUSION: (1) Dynesys dynamic stabilization system, as the most widely used non-fusion technology, which can obtain similar clinical efficacy with fusion. (2) Existing evidence shows that Dynesys internal fixation can maintain spinal stability, preserve partial motion of diseased vertebral segments, and reduce the load of facet joints and intervertebral disk pressure. (3) During long-term follow-up, complications such as screw loosening and poor correction of lumbar lordosis often occur after Dynesys internal fixation. (4) In addition, whether the degeneration of adjacent segments after rigid fixation is a natural development process or the role of internal fixation remains controversial. Long-term follow-up and large-sample studies are needed to clarify the mechanism.

Key words: dynamic stabilization system, Dynesys, lumbar vertebrae, non-fusion, degenerative diseases, internal fixation, biomechanics, adjacent segment degeneration

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R459.9