中国骨与关节杂志
中國骨與關節雜誌
중국골여관절잡지
Chinese Journal of Bone and Joint
2014年
11期
856-860
,共5页
宋红星%于波%沈惠良%于方%付胜良
宋紅星%于波%瀋惠良%于方%付勝良
송홍성%우파%침혜량%우방%부성량
椎管狭窄%椎间盘退行性变%腰椎%脊柱
椎管狹窄%椎間盤退行性變%腰椎%脊柱
추관협착%추간반퇴행성변%요추%척주
Spinal stenosis%Intervertebral disc degeneration%Lumbar vertebrae%Spine
目的：探讨Wallis系统治疗腰椎退行性疾病的中期临床疗效及适应证。方法回顾性分析2007年5月至2012年3月，应用Wallis棘突间动态稳定系统治疗的腰椎退行性病变共52例，男27例，女25例；年龄38～64岁，平均47.3岁。其中L4～5单节段48例，L4～S1双节段4例，均行腰椎开窗减压Wallis系统置入。观察术前及术后视觉疼痛评分( visual analogue scale，VAS )、Oswestry 残障指数评分( oswestry disability index，ODI )及下腰痛( Japanese orthopaedic association，JOA )评分变化情况，并测量术前及术后病变节段活动范围(rangeofmotion，ROM)及椎间盘后高度(posteriordischeight，PDH)。结果术后随访24～36个月，平均28.3个月。手术时间70～230 min，平均113.2 min。术中出血量20～300 ml，平均82.6 ml。手术节段PDH，术前(7.80±3.2) mm，末次随访时(7.20±0.7) mm，差异无统计学意义( P=0.09)，VAS评分、ODI评分和JOA评分术前分别为：(7.60±1.0、39.0±3.3和17.5±2.4)，末次随访分别为：(1.70±0.6、17.7±0.3和25.6±0.7)，差异均有统计学意义( P分别为0.003、0.005和0.007)。1例腰椎间盘突出症患者术后椎间盘突出复发，保守治疗缓解；另1例腰椎管狭窄症患者术后症状改善不明显，改行腰椎全椎板减压椎间融合固定术，症状缓解。其余病例末次随访时未发现假体移位等并发症，随访期间亦未出现节段不稳或邻近节段严重退变。结论应用 Wallis 动态稳定系统治疗腰椎退行性疾病，能保留手术节段腰椎的活动度，中期随访疗效良好，其主要适应证为退变不严重的腰椎管狭窄症。
目的：探討Wallis繫統治療腰椎退行性疾病的中期臨床療效及適應證。方法迴顧性分析2007年5月至2012年3月，應用Wallis棘突間動態穩定繫統治療的腰椎退行性病變共52例，男27例，女25例；年齡38～64歲，平均47.3歲。其中L4～5單節段48例，L4～S1雙節段4例，均行腰椎開窗減壓Wallis繫統置入。觀察術前及術後視覺疼痛評分( visual analogue scale，VAS )、Oswestry 殘障指數評分( oswestry disability index，ODI )及下腰痛( Japanese orthopaedic association，JOA )評分變化情況，併測量術前及術後病變節段活動範圍(rangeofmotion，ROM)及椎間盤後高度(posteriordischeight，PDH)。結果術後隨訪24～36箇月，平均28.3箇月。手術時間70～230 min，平均113.2 min。術中齣血量20～300 ml，平均82.6 ml。手術節段PDH，術前(7.80±3.2) mm，末次隨訪時(7.20±0.7) mm，差異無統計學意義( P=0.09)，VAS評分、ODI評分和JOA評分術前分彆為：(7.60±1.0、39.0±3.3和17.5±2.4)，末次隨訪分彆為：(1.70±0.6、17.7±0.3和25.6±0.7)，差異均有統計學意義( P分彆為0.003、0.005和0.007)。1例腰椎間盤突齣癥患者術後椎間盤突齣複髮，保守治療緩解；另1例腰椎管狹窄癥患者術後癥狀改善不明顯，改行腰椎全椎闆減壓椎間融閤固定術，癥狀緩解。其餘病例末次隨訪時未髮現假體移位等併髮癥，隨訪期間亦未齣現節段不穩或鄰近節段嚴重退變。結論應用 Wallis 動態穩定繫統治療腰椎退行性疾病，能保留手術節段腰椎的活動度，中期隨訪療效良好，其主要適應證為退變不嚴重的腰椎管狹窄癥。
목적：탐토Wallis계통치료요추퇴행성질병적중기림상료효급괄응증。방법회고성분석2007년5월지2012년3월，응용Wallis극돌간동태은정계통치료적요추퇴행성병변공52례，남27례，녀25례；년령38～64세，평균47.3세。기중L4～5단절단48례，L4～S1쌍절단4례，균행요추개창감압Wallis계통치입。관찰술전급술후시각동통평분( visual analogue scale，VAS )、Oswestry 잔장지수평분( oswestry disability index，ODI )급하요통( Japanese orthopaedic association，JOA )평분변화정황，병측량술전급술후병변절단활동범위(rangeofmotion，ROM)급추간반후고도(posteriordischeight，PDH)。결과술후수방24～36개월，평균28.3개월。수술시간70～230 min，평균113.2 min。술중출혈량20～300 ml，평균82.6 ml。수술절단PDH，술전(7.80±3.2) mm，말차수방시(7.20±0.7) mm，차이무통계학의의( P=0.09)，VAS평분、ODI평분화JOA평분술전분별위：(7.60±1.0、39.0±3.3화17.5±2.4)，말차수방분별위：(1.70±0.6、17.7±0.3화25.6±0.7)，차이균유통계학의의( P분별위0.003、0.005화0.007)。1례요추간반돌출증환자술후추간반돌출복발，보수치료완해；령1례요추관협착증환자술후증상개선불명현，개행요추전추판감압추간융합고정술，증상완해。기여병례말차수방시미발현가체이위등병발증，수방기간역미출현절단불은혹린근절단엄중퇴변。결론응용 Wallis 동태은정계통치료요추퇴행성질병，능보류수술절단요추적활동도，중기수방료효량호，기주요괄응증위퇴변불엄중적요추관협착증。
Objective To explore the interim effects and indications of the treatment of degenerative lumbar disease with Wallis interspinous dynamic stabilization system.Methods From May 2007 to March 2012, a retrospective analysis was done and 52 patients ( 27 males and 25 females ) with an average age of 47.3 years ( range: 38-64 years ) , receiving fenestration and stabilization using Wallis interspinous dynamic stabilization system, were reviewed. Segments involved: 48 cases with single segment at L4-5, 4 cases with double segments at L4-S1. Preoperatively and postoperatively, results of visual analogue scales ( VAS ), Oswestry disability index ( ODI ) and Japanese orthopaedic association ( JOA ) score were recorded and the range of motion ( ROM ) and posterior disc height ( PDH ) of operated segments were measured.Results 52 patients were followed up with an average of 28.3 months ( range: 24-36 months ). Mean time of surgery overall was 113.2 minutes ( range: 70-230 mins ). Average blood loss was 82.6 ml ( range: 20-300 ml ). The PDH of operated segments was ( 7.80±3.2 ) mm preoperatively, and ( 7.20±0.7 ) mm in the latest follow up. The preoperative VAS score, ODI score and JOA score was 7.60±1.0, 39.0±3.3 and 17.5±2.4 respectively, and 1.70±0.6, 17.7±0.3 and 25.6±0.7 respectively in the latest follow up. In the latest follow up, the PDH of the operative segments had no signiifcant difference compared with that of preoperation (P=0.09 ). Other data including VAS score, Oswestry score and JOA score were statistically and signiifcantly improved (P=0.003,P=0.005,P=0.007 respectively ). One patient with prolapse of lumbar intervertebral disc was diagnosed as recurrent herniation after the surgery, who received conservative treatment. Another patient with lumbar stenosis felt slight change after surgery, then the patient underwent extensive laminectomy and interbody fusion. Symptoms were relieved. No complications including prosthesis shift in other patients were found. No segment instability and severe degeneration of adjacent segments were found during the follow-up.Conclusions The clinical outcomes of Wallis in the treatment of degenerative lumbar diseases are satisfactory in the interim stage. The wallis dynamic stabilization system can retain the range of motion of the operated segments. It is a good choice for the treatment of lumbar stenosis without severe degeneration.
