Background:With the aging of population,the incidence of lumbar degeneration is increasing year by year.How to effectively treat such diseases is controversial.Objective:To compare the clinical efficacy of lumbar fusion and nonfusion in treatment of single segmental lumbar degenerative disease.Methods:A total of 97 patients with single segmental lumbar degenerative disease were selected and divided into two groups according to surgical procedures.Of them,51 patients were treated with posterior lumbar interbody fusion (PLIF group) and 46 were treated with Dynesys dynamic internal fixation (Dynesys group).Postoperative back pain (VAS score),clinical function (ODI score) and radiographic results (height and range of motion of intervertebral space of surgical segment,range of motion of upper adjacent segment) were compared between the two groups.Results:The mean duration of follow-up was (48.7±21.8) months in PLIF group (range,28-78 months) and (48.6±19.7) months in Dynesys group (range,27-76 months,P＞0.05).At the final follow-up,both VAS and ODI were improved significantly when compared with preoperative ones (P＜0.05),but there was no significant difference in VAS score between the two groups (P＞0.05),and patients in Dynesys group had a lower ODI than those in PLIF group (P＜0.05).The height of surgical segment intervertebral space increased at the final follow up in both groups.Compared with preoperative one,the height of surgical segment intervertebral space was significantly increased in Dynesys group (P＜0.05) at the final follow up,but no significant difference was found in PLIF group (P＞0.05).Range of motion of surgical segment was significantly lower at final follow up than that before surgery in both Dynesys group (6.9°±2.1° vs 4.6°± 1.3°) and PLIF group (7.2°±2.3° vs 0°,P＜0.05).Range of motion of upper adjacent segment was significantly higher at final follow up than that before surgery in both Dynesys group (7.8°±1.2° vs 8.6°±1.7°) and PLIF group (7.1°±2.6° vs 10.8°±2.6°,P＜0.05).Conclusions:Both of PLIF and Dynesys dynamic internal fixation have a satisfactory effect on single segmental lumbar degenerative disease,however,Dynesys dynamic internal fixation can partially maintain range of motion of surgical segment,has less impact on range of motion of the adjacent vertebra,and can theoretically reduce adjacent segment degeneration.%背景:随着人口老年化,腰椎退变性疾病发生率也逐年增加,如何有效治疗此类疾病,学术界尚存争议.目的:比较腰椎融合与非融合技术治疗单节段腰椎退变性疾病的临床疗效.方法:回顾分析97例单节段腰椎退变性疾病患者的临床资料,根据手术方式不同将患者分为采用后路腰椎融合术治疗单节段腰椎退变性疾病组(PLIF组,n=51)和采用Dynesys动态内固定治疗单节段腰椎退变性疾病组(Dynesys组,n=46).比较两组术后腰痛程度(VAS评分)、临床功能[Oswestry功能障碍指数(Oswestry disability index,ODI)]及术后影像学结果(手术节段椎间隙高度、活动度,上位邻近节段活动度).结果:PLIF组随访时间28～78个月,平均(48.7±21.8)个月;Dynesys组随访时间27～76个月,平均(48.6±19.7)个月;两组随访时间比较,差异无统计学意义(P＞0.05).末次随访时,两组VAS评分及ODI评分均较术前改善(P＜0.05),但组间比较,VAS评分差异无统计学意义(P＞0.05),Dynesys组患者ODI评分优于PLW组(P＜0.05).两组末次随访手术节段椎间隙高度均较术前增高,但PLIF组与术前比较差异无统计学意义(P＞0.05),而Dynesys组高于术前(P＜0.05).两组末次随访手术节段活动度均低于术前(P＜0.05),Dynesys组由术前6.9°±2.1°降低到4.6°土1.3°,而PLIF组由术前7.2°±2.3°降低到0°.两组末次随访时上位邻近节段活动度均较术前增加(P＜0.05),Dynesys组由术前7.8°±1.2°增加到8.6°±1.7°,PLIF组由术前7.1°±2.6°增加到10.8°±2.6°,且组间比较差异有统计学意义(P＜0.05).结论:PLIF与Dynesys动态内固定治疗单节段腰椎退变性疾病均能获得满意的临床疗效,但后者能够部分保留手术节段活动度,且对邻近椎体活动度影响较小,理论上可以降低邻近节段退变.
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