中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2012年
9期
788-791
,共4页
刘海鹰%谷爱奇%朱震奇%周健
劉海鷹%穀愛奇%硃震奇%週健
류해응%곡애기%주진기%주건
腰椎%椎间盘%椎间盘移位%椎管狭窄%内固定器%假体和植入物%复发
腰椎%椎間盤%椎間盤移位%椎管狹窄%內固定器%假體和植入物%複髮
요추%추간반%추간반이위%추관협착%내고정기%가체화식입물%복발
Lumbar vertebrae%Intervertebral disk%Intervertebral disk displacement%Spinal stenosis%Internal fixators%Prostheses and implants%Recurrence
目的 评价棘突间动态稳定装置Wallis治疗腰椎退行性疾病的中短期疗效,并对术后存在问题进行总结分析.方法 回顾性分析2009年1月至2010年6月收治的单节段腰椎间盘突出症伴或不伴腰椎管狭窄症的48例患者资料,其中男性30例,女性18例；年龄17 ～ 69岁,平均43岁.患者均行椎管开窗减压及Wallis棘突间置入术治疗,手术节段:L3～4 4例,L4～5 38例,L5～S1 6例.通过随访术前、术后腰腿痛视觉模拟量表( VAS)评分、Oswestry功能障碍指数(ODI)评分评估其临床症状改善情况,评估影像学变化.结果 患者术后均未发生手术相关并发症.术后随访12 ～ 30个月,平均(20±4)个月.ODI评分从术前46±10下降到末次随访时的24 ±7(t=12.765,P＜0.05),腰腿痛VAS评分从术前平均8.1±1.6下降到末次随访时的2.1±1.1(t=21.881,P＜0.05).6例患者于术后2～13个月出现椎间盘突出复发(6/48,12.5％),且均为L4～5节段；3例接受椎间盘切除及椎间融合术,另外3例保守治疗,症状均明显缓解.结论 Wallis治疗腰椎退行性疾病总体上中短期效果满意,能够显著缓解腰腿痛症状,但仍存在术后复发等问题.
目的 評價棘突間動態穩定裝置Wallis治療腰椎退行性疾病的中短期療效,併對術後存在問題進行總結分析.方法 迴顧性分析2009年1月至2010年6月收治的單節段腰椎間盤突齣癥伴或不伴腰椎管狹窄癥的48例患者資料,其中男性30例,女性18例；年齡17 ～ 69歲,平均43歲.患者均行椎管開窗減壓及Wallis棘突間置入術治療,手術節段:L3～4 4例,L4～5 38例,L5～S1 6例.通過隨訪術前、術後腰腿痛視覺模擬量錶( VAS)評分、Oswestry功能障礙指數(ODI)評分評估其臨床癥狀改善情況,評估影像學變化.結果 患者術後均未髮生手術相關併髮癥.術後隨訪12 ～ 30箇月,平均(20±4)箇月.ODI評分從術前46±10下降到末次隨訪時的24 ±7(t=12.765,P＜0.05),腰腿痛VAS評分從術前平均8.1±1.6下降到末次隨訪時的2.1±1.1(t=21.881,P＜0.05).6例患者于術後2～13箇月齣現椎間盤突齣複髮(6/48,12.5％),且均為L4～5節段；3例接受椎間盤切除及椎間融閤術,另外3例保守治療,癥狀均明顯緩解.結論 Wallis治療腰椎退行性疾病總體上中短期效果滿意,能夠顯著緩解腰腿痛癥狀,但仍存在術後複髮等問題.
목적 평개극돌간동태은정장치Wallis치료요추퇴행성질병적중단기료효,병대술후존재문제진행총결분석.방법 회고성분석2009년1월지2010년6월수치적단절단요추간반돌출증반혹불반요추관협착증적48례환자자료,기중남성30례,녀성18례；년령17 ～ 69세,평균43세.환자균행추관개창감압급Wallis극돌간치입술치료,수술절단:L3～4 4례,L4～5 38례,L5～S1 6례.통과수방술전、술후요퇴통시각모의량표( VAS)평분、Oswestry공능장애지수(ODI)평분평고기림상증상개선정황,평고영상학변화.결과 환자술후균미발생수술상관병발증.술후수방12 ～ 30개월,평균(20±4)개월.ODI평분종술전46±10하강도말차수방시적24 ±7(t=12.765,P＜0.05),요퇴통VAS평분종술전평균8.1±1.6하강도말차수방시적2.1±1.1(t=21.881,P＜0.05).6례환자우술후2～13개월출현추간반돌출복발(6/48,12.5％),차균위L4～5절단；3례접수추간반절제급추간융합술,령외3례보수치료,증상균명현완해.결론 Wallis치료요추퇴행성질병총체상중단기효과만의,능구현저완해요퇴통증상,단잉존재술후복발등문제.
Objectives To review degenerative lumbar disease treated with Wallis and the re-herniation cases after the implantation of Wallis,so as to evaluate the effect of the device. Methods From January 2009 to June 2010,a retrospective analysis was done and 48 patients (30 males and 18 females) with an average age of 43 years(ranging from 17 to 69 years),who received stabilization of the segment using the Wallis device,were reviewed.The involved segments included:4 cases at L3-4,38 cases at L4-5,6 cases at L5-S1. Preoperative and postoperative visual analogue scales (VAS) and Oswestry disability index (ODI) were recorded to evaluate the clinical efficiency,imageology diversity was assessed by X-rays and MRI. Results All cases received fenestration and the implantation of Wallis. No surgery related complications were recorded.There were 48 cases were followed up.The average follow-up period was (20 ± 4) months ( 12-30 months).The average ODI score dropped from 46 ± 10 to 24 ± 7 ( t =12.765,P ＜0.05).The average VAS for back and leg pain dropped from 8.1 ± 1.6 to 2.1 ± 1.1 ( t =21.881,P ＜0.05).Six patients with recurrent lower back and leg pain were diagnosed by MRl,as recurrent herniation (6/48,12.5％ ).All re-herniation occurred at L4-5 level,between 2 and 13 months after the surgery.Three of the 6 patients underwent additional discectomy and fusion, others received conservative treatment.Conclusions Although existing problems such as recurrence after surgery,the clinical outcome of Wallis in treating protrusion of lumbar intervertebral disc and lumbar stenosis is satisfied in middle-early stage.
