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目的 评估椎管减压椎弓根动态内固定系统治疗腰椎间盘突出症的临床疗效.方法 回顾性分析2012年6月至2014年7月应用髓核摘除联合Dynesys动态内固定系统治疗腰椎间盘突出症46例患者的效果.本组责任节段L4/5 17例,L5/S1 21例,L4/5合并L5/S1 8例,手术采用椎板开窗减压或部分切除,Dynesys动态内固定系统固定手术,按照视觉模拟评分(visual analogue scale,VAS)及Oswestry功能障碍指数评分(Oswestry Disability Index,ODI)评价其临床疗效,同时影像学观察并测量手术前后责任节段、责任节段头侧邻近节段及整个腰椎序列的曲度(Cobb角)及活动度(ROM).结果 术后随访6～48个月,平均18个月.本组病例均获得良好的临床效果.患者腰腿痛的VAS及ODI评分在术后各个随访时间点均较术前明显降低(P＜0.05).手术节段的Cobb角及ROM较术前显著减小(P＜O.05),但手术节段头侧邻近节段Cobb角较术前明显增加(P＜0.05),而ROM增加不明显(P＞0.05);整个腰椎序列的Cobb角及ROM较术前改变也不明显(P＞0.05).结论 髓核摘除联合Dynesys动态内固定系统治疗椎间盘突出,临床效果确切,症状显著缓解,在保留手术节段部分活动度的同时,又减少了临近节段的活动负荷,并且保留的整个腰椎序列的生理曲度,减缓了脊柱退变发生.“,”Objective To cxplorc thc clinical rcsult of dynamic pedicle screw internal fixation plus discectomy for lumbar disc herniation(LDH).Methods Retrospective analysis the clinical result of Fourty-six patients treated with dynamic fixation system(Dynesys) plus Discectomy between June 2012 and July 2014.The diseased level located at L4/5 in 17 cases.L5/S1 in 21 cases.LA/5 plus L5/S1 in 8 cases.All cases underwent discectomy and decomp-ression and dynamic fixation with Dynesys.VAS (visual analogue scale)and ODI (Oswestry Disability Index)scores were used to evaluate the results.Besides,measured the lordosis (Cobb's angles) and the range of motion (ROM) in diseased segments,diseased level rostral adjacent segment and the lumbar sequence according Radiographic outcome before and after surgery.Results The mean follow-up period was 18 months (range:6-48 months).The clinical effect of all patients was perfect.The comparisons showed significant improvements in back,leg VAS scores and ODI scores before and every follow-up time after surgery,respectively(P ＜ 0.05);The Cobb's angles and ROM was significant decrease in diseased segments after surgery(P ＜0.05),but the Cobb's angles in diseased level rostral adjacent segment was significant increase (P ＜ 0.05),while the change of ROM after surgery was not obvious (P ＞ 0.05),and the Cobb's angles and ROM in the lumbar sequence did not change significantly(P ＞ 0.05).Conclusion For LDH,discectomy and Dynesys placement is effectivein relieving the symptoms.Retained the part ROM of the diseased segments,reduced the activity load of the adjacent segment,while,retained the lordosis of the whole lumbar sequence,and delayed the degeneration or disease (ASD) in Adjacent segment.