| Background:Posterior lumbar intervertebral fusion(PLIF)which has been regarded as a gold standard to treat lumbar degenerative disc disease。but it is indeed not a perfect method-One of its drawbacks is adjacent segment degeneration(ASD)which was regarded as one of the risk factors which will induce low back and/or sciatic nerve pain recurrence, even some case need revision surgery. In order to avoid ASD, many technologies have been introducing by surgeons. The most noteworthy one is lumbar dynamic fixation which was regarded Can reduce the incidence of ASD by avoiding the biomechanical change on the adjacent segment. However.we have no ideal whether dynamic fixation Can prevent ASD or not. Dynamic neutralization system(Dynesys), which has been introduce to clinic more than10years, few published literatures have reported its validity. So we estimate the clinical outcome of lumbar rigid and semi-rigid internal fixation, respectively, then to contrast whether there is significant difference or not and whether to evaluate the risk factors affecting incidence ofASD.Part1To contrast the clinical outcome of Lumbar dynamic device (Dynesys dynamic stabilization system) and rigid lumbar fixationobjectives:To estimate the clinical outcome of Lumbar dynamic device (Dynesys dynamic stabilization system) and rigid lumbar fixation.Method:1. Collection dataThe subjects were patients with degenerative lumbar disease. Inclusion criterias:(1) patients suffering fi:om lumbar disc herniation,spondylolisthesis, lumbar spinal stenosis:(2) the course is more than half a year;(3) Adjacent segment does not get operation in the pre and postoperation;(4) the operation Was performed by the same surgeon;(5) PLIF and Dynesys;(6) operation time(2002.1-,2007.7);(7) Adjacent segment has been degenerative at preoperation(UCLA Ⅱ); (8) every operation is very successful.Divided the patients which is from our orthopedics into two group. In the DYNESYS systeml group,there are35cases meet the Inclusion criterias,and25cases(male16,female9)was followed up, average age is70±12ys(57-82ys).The span of follow-up is20±8months(12-26months). In th rigid fixation group, there are59cases meet the Inclusion criterias,and38cases(male24,female14) was followed up, average age is73±12ys(62-85ys).The span of follow-up is20±8months(12-27months).2. Evaluation index:Oswestry disability index(ODI)and visual analogue scale(VAS)are introduced to analyse the subjective sensation of patients.3.Significant analysisThe methods which calculate the data are paired-samples T test and analysis of covariance in SPSS13.0software,P<0.05isregared as that there is significant difference.Results:The situation of all of the Dynesys system cases:the ODI and VAS Was (31.25±8.191)%and6.28±1.02in preoperation,It was(8.36±2.69)%and3.28±1.24after surgery,(8.16±3.08)%and3.12±1.36in the last follow-up respectively. There ale statistic difference between different Periods about ODI and VAS, respectively(P<0.001). Excellent19cases(76.00%), good4cases(16.00%), fair2cases(8.00%), bad0cases(0.00%). The rate ofsatisfaction is90.00%.The situation of all of the rigid fuxation cases:the ODI and VAS Was (34.74±8.82)%and6.89±1.13in preoperation, It was (9.48±3.16)%and3.74±1.00after surgery,(9.42±3.38)%and3.58±1.13in the last follow-up respectively. There ale statistic difference between different Periods about ODI and VAS, respectively(P<O.001). excellent28case(73.68%), good7case(l18.42), fair3case(7.89%), bad0case(O.00%). The rate of satisfaction is92.10%.There is no significant difference on follow-up period and age when they received the lumbar operation between control group and experiment group. No significant difference was found on ODI and VAS in the time point of preoperation between the two groups. Reversely, we do not find significant difference on ODI and VAS between two groups in the last follow-up period, respectively. Satisfaction rate has no significant difference.Conclusion:There is no significant difference on follow-up period and age when they received the lumbar operation between control group and experiment group. No significant difference was found on ODI and VAS in the time point of preoperation between the two groups. Reversely, we do not find significant difference on ODI and VAS between two groups in the last follow-up period, respectively. Satisfaction rate has no significant difference. Both of them can get a good clinical outcome, and there is no significant difference(P>0.05).Part2The contrast investigation of Dynesys dynamic stabilization system versus rigid lumbar fixation on the Short-term adjacent segment degenerationObjectives:To analyse whether Dynesys system Can prevent ASD or not.And To analyse whether Dynesys system can protect the segment adjacent to the fusion one.Methods:1. Collection data is identical with Part2.2. Imaging evaluation is identical with Part2.3. Significant analysisThe methods which calculate the data are χ2test, One-Way ANOVA and independent-samples Ttest in SPSS13.0software, testing the standard of0.05.Results:Divided the patients which is from our orthopedics into two group. In the DYNESYS systeml group,there are35cases meet the Inclusion criterias,and25cases(male16,female9)was followed up, average age is70±12ys(57-82ys).The span of follow-up is20±8months(12-26months). In th rigid fixation group, there are59cases meet the Inclusion criterias,and38cases(male24,female14) was followed up, average age is73±12ys(62-85ys).The span of follow-up is20±8months(12-27months). There are8cases(31.58%)suffer from ASD in the rigid group. In the Dynesys group,1case(4.00%) suffers from ASD. There is significant difference between the two operation style on ASD(P<0.025).Conclusion:The Dynesys system Can protect the segment adjacent to the fusion segment, and prevent ASD(P<0.05). |
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