杨晓锋 宋先东 张兆伟 刘春 伍超 岳博宇

[摘要] 目的 系統评价Dynesys腰椎动态稳定系统与经后路腰椎椎间融合术PLIF对手术相邻节段退变的不同影响。 方法 计算机检索中国知网、万方数据库、重庆维普、PubMed等数据库，搜集比较Dynesys与PLIF两种术式对手术相邻节段腰椎退变影响的文献，检索文献为近6年国内外公开发表的文章，具体时间为2015年1月1日至2020年10月9日。 结果 本研究共纳入中文研究14个及英文研究3个，共计17个。描述两种术式对手术节段上位椎间隙高度H影响的研究共9项，描述两种术式对手术节段上位椎间活动度ROM影响的研究共15项，描述两种术式对手术节段下位椎间隙高度H影响的研究共4项，描述两种术式对手术节段下位椎间活动度ROM影响的研究共7项。 结论 Meta分析结果显示，两种术式对手术相近节段椎间隙高度的影响及对手术下节段椎间活动度的影响比较，差异均无统计学意义（P>0.05）;与Dynesys术相比，PLIF术可以更好地保留手术上节段椎间活动度，而Dynesys术并不能延缓手术相邻节段的退变。

[关键词] 腰椎动态稳定系统;后路腰椎椎间融合术;腰椎退行性变;Meta分析;相邻节段

[中图分类号] R687.4          [文献标识码] A          [文章编号] 1673-9701（2021）09-0019-07

Meta-analysis of the influence of Dynesys lumbar dynamic stabilization system and posterior lumbar interbody fusion on the degeneration of adjacent segments

YANG Xiaofeng1   SONG Xiandong2   ZHANG Zhaowei1   LIU Chun1   WU Chao1   YUE Boyu1

1.Mudanjiang Medical University， Mudanjiang   157011， China; 2.the Third Department of Orthopedics， Hongqi Hospital Affiliated to Mudanjiang University， Mudanjiang   157011， China

[Abstract] Objective To systematically evaluate the different effects of Dynesys lumbar dynamic stabilization system on the degeneration of adjacent segments after posterior lumbar interbody fusion（PLIF）. Methods By searching China National Knowledge Infrastructure， Wanfang database， NoteExpress， PubMed and other databases， the effects of Dynesys and PLIF on adjacent segmental lumbar degeneration were collected and compared. The searched literature included articles published at home and abroad in the past 6 years from January 1， 2015 to October 9， 2020. Results A total of 17 literatures were included in this research， including 14 Chinese studies and 3 English studies. There were 9 studies describing the effects of two surgical procedures on the height（H） of the upper intervertebral space of the surgical segment， and 15 studies describing the effects of the two surgical procedures on the range of motion （ROM） of the upper intervertebral space of the surgical segment. There were a total of 4 studies on the influence of the H of the lower intervertebral space， and a total of 7 studies describing the influence of the ROM of the lower intervertebral space of the surgical segment. Conclusion The Meta-analysis showed that the effects of the two procedures on the height of the intervertebral space in the similar segments and the effects on the ROM of the lower segments were not statistically significant（P>0.05）. Compared with Dynesys， PLIF could better preserve the intervertebral motion of the upper segments， while Dynesys could not delay the degeneration of the adjacent segments.

[Key words] Lumbar dynamic stabilization system; Posterior lumbar interbody fusion; Lumbar degeneration; Meta-analysis; Adjacent segments

随着社会的不断发展、生活方式节奏的改变及我国国内老龄化社会的进一步加深，腰椎退行性变的发病率呈逐年上升趋势，虽然绝大多数患者经过保守治疗能够得到有效缓解甚至治愈，但仍有部分患者需要进行外科手术治疗。中、长期的术后随访结果显示，作为传统术式的PLIF术存在术后融合节段活动丧失、相邻节段退变加速、假关节形成等并发症，进而增加二次手术概率[1]。于是……