CAJ | 학술논문

背景:长期以来,脊柱融合术一直是治疗腰椎间盘退变疾病的“金标准”,但是坚强的后路固定器械和椎间融合牺牲了腰椎的活动度,并造成应力集中,往往导致固定相邻节段椎间盘的退变,并且一部分相邻节段的退行性变可引起临床症状,影响预后,成为脊柱内固定术后一个潜在的长期并发症. 目的:探讨WavefleX动态稳定系统治疗腰椎间盘退变性疾病的初步临床疗效. 方法:回顾分析2009年11月至2011年12月,我院应用 WavefleX 系统治疗腰椎间盘退变性疾病34例,男16例,女18例,年龄35~72岁,平均(54.8±7.9)岁.根据椎间盘退变程度,采用椎管减压、椎间融合或不融合、植入WavefleX系统固定.观察手术前后简化McGill疼痛评分(SF-MPQ)、疼痛视觉类比(VAS)评分、Oswestry功能障碍指数(ODI),整个腰椎以及动态固定节段的活动范围(ROM),节段融合情况. 结果:术后随访4~32个月,平均(17.0±1.6)个月.手术时间80~210 min,平均(160.0±7.4)min,术中出血量150~700 ml,平均(300.0±8.3)ml.术后 SF-MPQ、VAS 评分、ODI 明显改善,与术前相比差异具有统计学意义(P<0.05).手术前后腰椎及动态固定节段ROM无明显减低(P>0.05). 结论:WavefleX系统是治疗腰椎间盘退变性疾病的一种安全、有效的外科方法,对病变节段能提供稳定力学环境,同时保留部分活动度,利于缓解椎间盘退变,对邻近节段活动度影响不大,可能延缓邻近椎间盘退变.
배경:장기이래,척주융합술일직시치료요추간반퇴변질병적“금표준”,단시견강적후로고정기계화추간융합희생료요추적활동도,병조성응력집중,왕왕도치고정상린절단추간반적퇴변,병차일부분상린절단적퇴행성변가인기림상증상,영향예후,성위척주내고정술후일개잠재적장기병발증. 목적:탐토WavefleX동태은정계통치료요추간반퇴변성질병적초보림상료효. 방법:회고분석2009년11월지2011년12월,아원응용 WavefleX 계통치료요추간반퇴변성질병34례,남16례,녀18례,년령35~72세,평균(54.8±7.9)세.근거추간반퇴변정도,채용추관감압、추간융합혹불융합、식입WavefleX계통고정.관찰수술전후간화McGill동통평분(SF-MPQ)、동통시각류비(VAS)평분、Oswestry공능장애지수(ODI),정개요추이급동태고정절단적활동범위(ROM),절단융합정황. 결과:술후수방4~32개월,평균(17.0±1.6)개월.수술시간80~210 min,평균(160.0±7.4)min,술중출혈량150~700 ml,평균(300.0±8.3)ml.술후 SF-MPQ、VAS 평분、ODI 명현개선,여술전상비차이구유통계학의의(P<0.05).수술전후요추급동태고정절단ROM무명현감저(P>0.05). 결론:WavefleX계통시치료요추간반퇴변성질병적일충안전、유효적외과방법,대병변절단능제공은정역학배경,동시보류부분활동도,리우완해추간반퇴변,대린근절단활동도영향불대,가능연완린근추간반퇴변.
@@@@Background: Spinal fusion has been the gold standard for the treatment of lumbar degenerative disc diseases. But spinal fu-sion may result in adjacent segment degeneration. @@@@Objective: To explore preliminary clinical outcomes of the WavefleX dynamic stabilization system in the treatment of lum-bar degenerative disc diseases. @@@@Methods: Thirty-four patients with lumbar degenerative disc diseases were treated with the WavefleX system from Novem-ber 2009 to December 2011, including 16 males and 18 females with an average age of (54.8±7.9) years (range, 35-72 years). According to the severity of degenerative disc, surgical procedures including decompression with or without inter-body fusion (PLIF) and dynamic stabilization with WavefleX system were performed. The VAS, ODI were scored to evalu-ate the clinical efficacy. Range of motion (ROMs) of each instrumented levels, one segment above and below this instrumen-tation and whole lumbar were evaluated before and after operation.The fusion segments were also observed. @@@@Results: The average follow up period was (17.0±1.6) years (range, 4-32 months). The operation time was (160.0±7.4) min (range, 80 to 210 min). The volume of blood loss was (300.0±8.3) ml (range, 150-700 ml). There was a significant improve-ment in the VAS and ODI scores between preoperation and postoperation (P<0.05). ROM of instrumented levels and whole lumbar showed a decrease in non-fused segment and a significant decrease in fused level(P<0.05). ROM of adjacent level increased, but statistically invalid. @@@@Conclusions: The preliminary clinical results show the WavefleX system is a safe and effective technique in treatment of lumbar disc degenerative diseases. The system assists in physiological motion and stabilization at the instrumented level, which prenvent instrumented level degeneration and may prevent adjacent segment degeneration.