CAJ | 학술논문

背景:为保证可控制范围内的脊柱运动,改变失稳节段运动的负荷模式,并限制其异常活动,同时避免相邻节段椎间盘退变的发生,多种后路腰椎非融合固定装置被研发并用于临床.目的:探讨Wallis动态稳定系统治疗腰椎失稳症的临床效果.方法:选择中山大学附属第一医院脊柱外科收治的腰椎失稳症患者10例,男3例,女7例,年龄43-65岁,其中失稳节段1例为L_(1/2)和L_(4/5),1例为L_(2/3),1例为L_(3/4),其余均为L_(4/5)倒合并相同节段腰椎间盘突出症2例,腰椎管狭窄症7例,相邻节段腰椎管狭窄症3例:失稳节段均行后路椎管减压、Wallis置入固定治疗.观察治疗前后视觉模拟VAS评分、下腰痛JOA评分、Oswestry功能障碍指数变化;失稳节段和相邻节段的活动范围及L_(4/5)节段椎间盘后高度的变化.结果与结论:10例患者均获得随访,随访时间2-13个月,平均9.2个月.手术时间平均128 min(90-185 min),术中平均出血量264 mL(50-600 mL).腰痛均消失,术后患者的症状和体征均有明显改善;1例置入治疗后3个月因L_(4/5)右侧腰椎管狭窄症复发,再行开窗减压术后症状消失.治疗后VAS评分较术前显著降低(P=0.003);JOA评分较术前显著增加(P=0.002),ODI评分较术前显著降低(P=0.008).术后L_(4/5)节段的活动范围与术前相比明显减少(P<0.05),而术后相邻节段L_(3/4)、L_5/S_1的活动范围与术前相比差异无显著性意义(p>0.05).提示Wallis动态稳定系统置入治疗腰椎失稳症能够取得比较满意的临床效果.
배경:위보증가공제범위내적척주운동,개변실은절단운동적부하모식,병한제기이상활동,동시피면상린절단추간반퇴변적발생,다충후로요추비융합고정장치피연발병용우림상.목적:탐토Wallis동태은정계통치료요추실은증적림상효과.방법:선택중산대학부속제일의원척주외과수치적요추실은증환자10례,남3례,녀7례,년령43-65세,기중실은절단1례위L_(1/2)화L_(4/5),1례위L_(2/3),1례위L_(3/4),기여균위L_(4/5)도합병상동절단요추간반돌출증2례,요추관협착증7례,상린절단요추관협착증3례:실은절단균행후로추관감압、Wallis치입고정치료.관찰치료전후시각모의VAS평분、하요통JOA평분、Oswestry공능장애지수변화;실은절단화상린절단적활동범위급L_(4/5)절단추간반후고도적변화.결과여결론:10례환자균획득수방,수방시간2-13개월,평균9.2개월.수술시간평균128 min(90-185 min),술중평균출혈량264 mL(50-600 mL).요통균소실,술후환자적증상화체정균유명현개선;1례치입치료후3개월인L_(4/5)우측요추관협착증복발,재행개창감압술후증상소실.치료후VAS평분교술전현저강저(P=0.003);JOA평분교술전현저증가(P=0.002),ODI평분교술전현저강저(P=0.008).술후L_(4/5)절단적활동범위여술전상비명현감소(P<0.05),이술후상린절단L_(3/4)、L_5/S_1적활동범위여술전상비차이무현저성의의(p>0.05).제시Wallis동태은정계통치입치료요추실은증능구취득비교만의적림상효과.
BACKGROUND: Posterior lumbar non-fusion devices have been developed to control vertebral column movement, change load pattern of instability segment, restrict abnormal action, as well as avoid adjacent segment degeneration.OBJECTIVE: To investigate the efficiency of Wallis dynamic stabilization system in the treatment of lumbar vertebrae instability.METHODS: Ten cases suffering from lumbar instability were selected, including 3 males and 7 females, aged 43-65 years. One patient sustained L_(1/2) and L_(4/5) segmental instability, one was L_(2/3) and another was L_(3/4), and the others were L_(4/5). Two patients complicated with lumbar disc herniation and 7 patients combined with lumbar spinal stenosis at the same affected segment, and 3 patients associated with lumbar spinal stenosis at adjacent segment. All unstable segments were treated with decompression, posterior implantation of Wallis dynamic stabilization system. Visual analogue scale (VAS) and Japanese Orthopedic Association (JOA) scores for low back pain and Oswestry disability index (ODI) were used to evaluate clinical outcomes. In addition, therange of motion (ROM) at the instrumented segment and adjacent segments and posterior disc height (PDH) in standing and extension position at L_(4/5) segment were also measured.RESULTS AND CONCLUSION: All the patients were followed-up for 2-13 months, mean 9.2 months. The mean operation duration was 128 minutes (90-185 minutes), with bleeding volume of 264 Ml (50-600 Ml). Sings and symptoms of all patients were improved significantly after operation, except one patient with recurrence of L_(4/5) lumbar spinal stenosis at 3 month after surgery, whose symptoms relieved by revision with fenestration and decompression. The postoperative VAS was dramatically decreased than that of preoperation (P=0.003); the JOA score was obviously increased (P=0.002), and the ODI score was decreased (p=0.008). The postoperative range of motion decreased significantly (P<0.05). However, there was no obviously difference between preoperative and postoperative L_(3/4), L_5/S_1 and posterior disc height (P>0.05). Good clinical results can be achieved by surgical intervention with Wallis dynamic stabilization system in treating lumbar vertebrae instability.