CAJ | 학술논문

目的：总结和分析Wallis棘突间动态稳定系统治疗腰椎退行性疾病的中期疗效及并发症发生情况。方法回顾性分析2008年7月至2013年3月采用Wallis棘突间动态稳定系统治疗的130例腰椎退行性疾病患者的临床资料。采用视觉模拟量表（VAS）评分评定临床症状改善情况，腰痛日本骨科学会（JOA）评分、Oswestry功能障碍指数（ODI）评分评价术后功能恢复情况；通过腰椎正侧位及动力位X线片检查，测量和比较手术前后手术节段椎间盘平均高度（DH）和活动度（ROM）；观察术中、术后并发症并分析其原因。结果130例患者中127例获得完整随访，随访时间13～58个月（平均38.4个月）。末次随访时患者VAS、JOA及ODI评分均较术前明显改善（P＜0.05）；末次随访时手术节段DH与术前相比，差异无统计学意义[（11.3±1.8）cm vs（11.4±1.8）cm，P＞0.05），ROM则较术前显著降低[（22.0±10.0）° vs（25.5±10.1）°，P＜0.05]。6例（4.7%）患者出现并发症，1例术中假体爆裂、2例术后分别出现手术节段及邻近节段椎间盘突出复发、2例术后感染（浅部和深部感染各1例）、1例术后顽固性腰痛。结论Wallis棘突间动态稳定系统治疗腰椎退行性疾病中期疗效确切，安全性好，但存在一定并发症风险，应严格把握适应证。
목적：총결화분석Wallis극돌간동태은정계통치료요추퇴행성질병적중기료효급병발증발생정황。방법회고성분석2008년7월지2013년3월채용Wallis극돌간동태은정계통치료적130례요추퇴행성질병환자적림상자료。채용시각모의량표（VAS）평분평정림상증상개선정황，요통일본골과학회（JOA）평분、Oswestry공능장애지수（ODI）평분평개술후공능회복정황；통과요추정측위급동력위X선편검사，측량화비교수술전후수술절단추간반평균고도（DH）화활동도（ROM）；관찰술중、술후병발증병분석기원인。결과130례환자중127례획득완정수방，수방시간13～58개월（평균38.4개월）。말차수방시환자VAS、JOA급ODI평분균교술전명현개선（P＜0.05）；말차수방시수술절단DH여술전상비，차이무통계학의의[（11.3±1.8）cm vs（11.4±1.8）cm，P＞0.05），ROM칙교술전현저강저[（22.0±10.0）° vs（25.5±10.1）°，P＜0.05]。6례（4.7%）환자출현병발증，1례술중가체폭렬、2례술후분별출현수술절단급린근절단추간반돌출복발、2례술후감염（천부화심부감염각1례）、1례술후완고성요통。결론Wallis극돌간동태은정계통치료요추퇴행성질병중기료효학절，안전성호，단존재일정병발증풍험，응엄격파악괄응증。
Objective To summarize and analyze the mid-term efficacy and complications of Wallis interspinous dynamic stabilization system for lumbar degenerative diseases (LDD). Methods From July 2008 to March 2013, 130 patients with LDD were treated by Wallis interspinous implants in Guangdong General Hospital, and clinical data of the patients were analyzed retrospectively. Symptoms were assessed by visual analogue scale (VAS), lumbar functions were evaluated according to Japanese Orthopaedic Association (JOA) score and Oswestry disability index (ODI); The disc height (DH) and range of motion (ROM) of the operated segments were determined by lumbar plane and dynamic X-ray to assess the biomechanical changes before and after the operation; Intraoperative and postoperative complications were observed and then the causes were analyzed. Results There were 127 cases had completed the follow-up and the average time was 38.4 months (13-58 months). At the final follow-up, VAS, JOA and ODI scores were better than preoperative ones (P<0.05);DH of the operated segments was (11.3 ± 1.8) cm which had no significant difference when comparing with preoperative DH [(11.4 ± 1.8) cm] (P >0.05), while ROM was less than preoperative one [(22.0 ± 10.0)° vs (25.5 ± 10.1)°, P<0.05]. The complication rate was 4.7% (6/127), in which 1 case with spacer breakage during the operation, 2 cases with disc herniation recurrence at operated segment and adjacent segment respectively, 2 cases with infections (1 case in superficial and 1 case in deep infection), and 1 case with continuous low back pain. Conclusion The application of Wallis interspinous dynamic stabilization system for LDD could achieve definite mid-term effects and safety, but proper indications should be evaluated strictly due to its potential risk of complications.