Kocak T, Cakir B, Däxle M, Reichel H, Käfer W, Mattes T
Orthopädie, Universitätsklinik, Ulm.
Z Orthop Unfall. 2009 Mar-Apr;147(2):210-4. doi: 10.1055/s-0029-1185520. Epub 2009 Apr 8.
Several non-fusion technologies have been developed as an alternative to fusion procedures in the past decades, in order to avoid typical problems related to fusion. The Dynesys (Zimmer, USA), which was inaugurated 7 years ago, consists of pedicle screws, flexible spacers and cords and is intended to control segmental motion and to realign the lumbar spine. Since this device is new, it was the goal of this study to analyse the perioperative morbidity of lumbar stabilisation with Dynesys retrospectively.
136 patients (74 men and 62 women) underwent posterior stabilisation of the lumbar spine with Dynesys between January 2002 and April 2006. We acquired retrospectively several patient-related variables, e.g. the number of instrumented and decompressed segments, the perioperative blood loss, the operation duration, prior surgeries and technical and general complications.
The average age of the patients was 61.2 years (range: 33-84). 1.6 segments (range: 1-3) were instrumented and 1.2 segments (range: 0-3) were decompressed on average. The mean perioperative blood loss was 1100 ml (range: 50-3400) and the mean operation duration was 127.1 minutes (range: 30-270). Eighteen patients (13.2 %) had a urinary tract infection and 5 patients (3.7 %) had cardiovascular complications. Dura lesions were seen in 11 patients (8.1 %) with 1 patient having persistent bladder symptoms. Revision surgery was necessary in 3 patients (2.2 %) due to screw malposition with neurological deficits and radicular pain. Five patients (3.7 %) were revised due to postoperative seroma, 2 of them developing superficial infection.
The perioperative morbidity of lumbar stabilisation with Dynesys seems to be similar to posterior fusion techniques. However, an additional morbidity due to interbody fusion, which may necessitate also autogenous bone, is avoided.
在过去几十年中，已经开发了几种非融合技术作为融合手术的替代方法，以避免与融合相关的典型问题。7年前问世的Dynesys（美国捷迈公司）由椎弓根螺钉、弹性间隔物和束带组成，旨在控制节段性运动并使腰椎重新排列。由于该装置是新的，本研究的目的是回顾性分析使用Dynesys进行腰椎稳定手术的围手术期发病率。
2002年1月至2006年4月期间，136例患者（74例男性和62例女性）接受了使用Dynesys的腰椎后路稳定手术。我们回顾性收集了几个与患者相关的变量，例如植入和减压节段的数量、围手术期失血量、手术持续时间、既往手术以及技术和全身并发症。
患者的平均年龄为61.2岁（范围：33 - 84岁）。平均植入1.6个节段（范围：1 - 3个），平均减压1.2个节段（范围：0 - 3个）。围手术期平均失血量为1100毫升（范围：50 - 3400毫升），平均手术持续时间为127.1分钟（范围：30 - 270分钟）。18例患者（13.2%）发生尿路感染，5例患者（3.7%）出现心血管并发症。11例患者（8.1%）出现硬脊膜损伤，其中1例患者有持续的膀胱症状。3例患者（2.2%）因螺钉位置不当伴有神经功能缺损和神经根性疼痛而需要翻修手术。5例患者（3.7%）因术后血清肿而进行翻修，其中2例发生浅表感染。
使用Dynesys进行腰椎稳定手术的围手术期发病率似乎与后路融合技术相似。然而，避免了因椎间融合导致的额外发病率，椎间融合可能还需要自体骨。
