三种开放手术方式治疗腰4/5椎间盘突出症的疗效对比

doi:10.3969/j.issn.1006-6233.2018.07.025

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Abstract Objective: To evaluate the clinical and radiographic results of three surgical methods namely dynesys, discectomy, and spinal fusion and internal fixation in the treatment of lumbar degenerative disease. Memods:Among the 82 cases of lurnbar degenerative disease from July 2010 to July 2013, 26 patients were treated with Dynesys procedure (Group A), 32 with spinal fusion and internal fixation (Group B) and 24 with discectomy (Group C). The follow-up periods were made between 2 and 3 years, an average of 2.4 years. Clinical outcomes in term of range of motion(ROM), intervenebral height of lumbar segments and ROM of adjacent segment were evaluated by visual analogue scale (VAS) and 0swestry disability index (ODI). Results: Group C with discectomy was much less than the other two(P<0.05)in terms of operation time and amount of bleeding while Group A with Dynesys was lower than the Group treated with spinal fusion and internal fixation(P<0.05). All 3 groups at the last follow-up have seen significant improvements in VAS and ODI figures compared with the numbers before operation (P<0.05) and the disparity among them makes no difference statistically (p>0.05). The intervenebral heights of lumbar segments for the three had not shown any dramatic variation before surgery (p>0.05)while the figure of Group B with spinal fusion and internal fixation increased significantly and the one of Group C dropped at the last follow-up (P<0.05). At the last follow-up the ROM of Group C had barely changed significantly compared with preoperative period(p>0.05)while the spinal fusion and internal fixation group and the Dynesys group decreased remarkably(P<0.05). During the preoperative period, there were no marked disparity in ROM of adjacent segment among the three groups(p>0.05)while at the last follow-up Group B with spinal fusion and internal fixation and Group C with Dynesys have both increased compared with their preoperative figures(P<0.05)and the discectomy group has remained unchanged (p>0.05). Conclusions:The three methods can all produce good results. Considering operation time and amount of bleeding discectomy is better than the other two groups; spinal fusion and internal fixation and Dynesys are more preferred than discectomy in opening lesion segments; and discectomy and Dynesys can equally maintain the ROM of parts of lesion segments, but the latter can achieve a better balance between ROM and stability, preventing effectively further lesion segment degeneration.

Key words： Lumbar spine Dynesys system Fusion and internal fixation Discectomy

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	MA Shuwei
	WU Jigong

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MA Shuwei,WU Jigong. Effective Comparing of three Types of Open Surgery in the treatment of L4/5 Intervertebral Disc Protrusion[J]. HeBei Med, 2018, 24(7): 1155-1160.

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http://www.hbyxzzs.cn/EN/10.3969/j.issn.1006-6233.2018.07.025 OR http://www.hbyxzzs.cn/EN/Y2018/V24/I7/1155

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