摘要
背景:腰椎融合术一直被认为是治疗腰椎间盘退变性疾病的金标准。但有文献报道,腰椎融合术加速相邻节段的退变,因此提出了非融合技术。目的:探讨棘突间动态稳定系统(interspinous dynamic stabilization system,IDSS)植入在预防相邻节段退变(adjacent segment degeneration,ASD)中的作用。方法:回顾性分析2007年7月至2010年10月应用Wallis棘突间动态稳定系统(WIDSS)治疗单纯L4-L5节段椎间盘源性腰痛(discogenic low back pain,DLBP)患者的临床资料。共33例患者,男13例,女20例;年龄30～63岁,平均(46.2±12.3)岁。临床疗效采用腰痛的视觉模糊评分(visual analogue scale,VAS)及Oswestry功能障碍指数(Oswestry disability index,ODI)进行评价。摄X线片测量病变节段以及相邻节段活动范围(range of motion,ROM)及椎间盘高度(disc height,DH)的变化。结果:所有患者均获随访,随访时间18～52个月,平均32个月。腰痛VAS评分由术前的(7.8±1.4)分降至随访时的(2.5±1.6)分,ODI由术前的(69.3±8.5)%减至随访时的(27.3±9.4)%,术前与随访时的VAS、ODI比较有统计学差异(P<0.05)。手术节段DH由术前(9.6±1.1)mm增至随访时(9.9±1.5)mm,ROM由术前的(14.2±1.7)°减少至随访时为(7.8±2.5)°,两者术前与随访时比较,差异有统计学意义(P<0.05)。但上下相邻节段的DH、ROM术前与随访时对比均无明显差异(P>0.05)。结论:WIDSS在有效治疗DLBP的同时,保留了手术节段的一定活动度,不增加邻近节段的活动度及退变发生率,对相邻节段的退变具有一定的保护作用。
Background： Lumbar spinal fusion has been recognized as the gold standard for treatment of disc degenerative disease, but it has been reported that lumbar spinal fusion can accelerate the degeneration of adjacent segments. So the lumbar non-fu- sion has been proposed. Objective： The purpose of the study is to investigate the effect of interspinous dynamic stabilization system 0DSS） in prevention of adjacent segment degeneration （ASD）. Methods： The clinical data of 33 patients who were treated by Wallis IDSS for L4-L5 discogenic low back pain （DLBP） between July 2007 and October 2010 were retrospectively analyzed. There were 13 males and 20 females with an average age of （46.2±12.3） years （range, 30-63 years）. The visual analogue scale （VAS） and Oswestry disability index （ODI） were used to evaluate clinical outcomes. The disc height and range of motion （ROM） were measured before surgery and at the follow-up. Results： The follow-up lasted for 32 months on average （range, 18-52 months） in all patients. The postoperative VAS and ODI were significantly lower than preoperative ones （VAS： 7.8±1.4 vs 7.8±1.4, ODI： 69.3%±8.5% vs 27.3%±9.4%, P〈 0.05）. The disc height of involved segments increased from （9.6±1.1） cm preoperatively to （9.9±1.5） at the last follow-up, and the ROM of involved segments decreased from （14.2±1.7）°preoperatively to （7.8±2.5）°at the last follow-up （P〈0.05）. But there were no significant differences in disc height and ROM of adjacent segments before surgery and at the last follow-up （P〉0.05）. Conclusions： Wallis IDSS is an effective technique in treatment of DLBP. Meanwhile, it can maintain the physiological activity of the involved vertebrae, and does not increase the stress of the adjacent segments and the incidence of degeneration.
出处
《中国骨与关节外科》
2013年第2期117-120,125,共5页
Chinese Journal of Bone and Joint Surgery
关键词
腰椎
非融合
Wallis系统
椎间盘源性腰痛
相邻节段退变
Lumbar vertebra
Non-fusion
Wallis system
Discogenic low back pain
Adjacent segment degeneration
