Wallis棘突间动态稳定系统治疗腰椎管狭窄患者的疗效
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摘要
目的探讨Wallis棘突间动态稳定系统在治疗老年腰椎管狭窄中的疗效及对患者术后功能的影响。方法纳入2014年1月至2016年3月在我院接受手术治疗的腰椎管狭窄患者104例,按照随机数字表法分为Wallis组和融合组,各52例;Wallis组采用Wallis棘突间动态稳定系统治疗,融合组采用腰椎减压融合内固定术治疗;随访两组患者术后神经功能评分(JOA)、视觉疼痛评分(VAS)、Oswestry功能障碍指数(ODI);比较两组患者手术前后椎间隙前后缘高度(Intervertebral space height,ISH)、椎间盘高度(disc height,DH)、手术节段活动范围(range of motion,ROM);记录两组患者术后出现脑脊液漏、顽固性腰痛、椎体滑脱等并发症情况。结果与术前比较,术后12个月两组患者JOA、VAS、ODI评分均有不同程度改善(P<0.05);术后12个月,Wallis组JOA评分高于融合组,VAS、ODI评分低于融合组,差异显著(P<0.05);与术前比较,术后12个月Wallis组ISH、DH、ROM无明显变化(P>0.05);术后12个月融合组ISH、DH明显降低(P<0.05),ROM明显增加(P<0.05);术后12个月Wallis组ISH、DH高于融合组,ROM低于融合组,差异显著(P<0.05);随访12个月,Wallis组并发症发生率为7.69%(4/52),融合组并发症发生率为26.92%(14/52),比较差异具有统计学意义(P<0.05)。结论与传统腰椎减压融合术比较,Wallis棘突间动态稳定系统能够有效改善患者神经功能及临床症状,并发症少,值得临床推广。
Objective To explore the effect of Wallis interspinous dynamic stabilization system in the treatment of elderly lumbar spinal stenosis and its effect on postoperative function. Methods A total of 104 patients with lumbar spinal stenosis who underwent surgery in our hospital from January 2014 to March 2016 were enrolled. According to the random number table, there were 52 cases in Wallis group underwent Wallis interspinous dynamic stabilization system fixation, and 52 cases in the fusion group treated with lumbar decompression and internal fixation. The neurological function score(JOA), visual pain score(VAS) and Oswestry dysfunction index(ODI) were studied. Before and after surgery, the intervertebral space height(ISH), the disc height(DH), and the range of motion(ROM) were recorded. The cerebrospinal fluid leakage and stubbornness were recorded in the two groups. Complications such as low back pain and vertebral spondylolisthesis were studied as well. Results In both groups, it showed that JOA, VAS and ODI scores improved 12 months after operation(P<0.05). JOA scores in Wallis group were higher than that of the fusion group, but VAS and ODI scores were lower(P<0.05). There were no significant changes of ISH, DH and ROM in Wallis group 12 months after operation( P>0.05). In the fusion group,ISH and DH were significantly decreased and ROM was significantly increased after operation( P>0.05). 12 months after operation,it showed significantly differences between the two groups,with higher ISH and DH,and lower ROM in Wallis group( P>0.05). During 12 months of follow-up,the incidence of complications was 7.69%( 4/52) in Wallis group and 26.92%( 14/52) in the fusion group( P<0.05). Conclusion Compared with traditional lumbar decompression and fusion,Wallis interspinous dynamic stabilization system can effectively improve the neurological function and clinical symptoms with less complications,which is worthy of clinical promotion.
Objective To explore the effect of Wallis interspinous dynamic stabilization system in the treatment of elderly lumbar spinal stenosis and its effect on postoperative function. Methods A total of 104 patients with lumbar spinal stenosis who underwent surgery in our hospital from January 2014 to March 2016 were enrolled. According to the random number table, there were 52 cases in Wallis group underwent Wallis interspinous dynamic stabilization system fixation, and 52 cases in the fusion group treated with lumbar decompression and internal fixation. The neurological function score(JOA), visual pain score(VAS) and Oswestry dysfunction index(ODI) were studied. Before and after surgery, the intervertebral space height(ISH), the disc height(DH), and the range of motion(ROM) were recorded. The cerebrospinal fluid leakage and stubbornness were recorded in the two groups. Complications such as low back pain and vertebral spondylolisthesis were studied as well. Results In both groups, it showed that JOA, VAS and ODI scores improved 12 months after operation(P<0.05). JOA scores in Wallis group were higher than that of the fusion group, but VAS and ODI scores were lower(P<0.05). There were no significant changes of ISH, DH and ROM in Wallis group 12 months after operation( P>0.05). In the fusion group,ISH and DH were significantly decreased and ROM was significantly increased after operation( P>0.05). 12 months after operation,it showed significantly differences between the two groups,with higher ISH and DH,and lower ROM in Wallis group( P>0.05). During 12 months of follow-up,the incidence of complications was 7.69%( 4/52) in Wallis group and 26.92%( 14/52) in the fusion group( P<0.05). Conclusion Compared with traditional lumbar decompression and fusion,Wallis interspinous dynamic stabilization system can effectively improve the neurological function and clinical symptoms with less complications,which is worthy of clinical promotion.
引文
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[6] 邓勇,向静.腰椎后路动态稳定系统修复退行性腰椎椎管狭窄:疗效及安全性分析[J].中国组织工程研究,2018,22(15):2333-2339.
[7] Pan Z,Yoon H,Yi S,et al.Efficacy of transforaminal endoscopic spine system (TESSYS) technique in treating lumbar disc herniation[J].Med Sci Monit,2016,22(2):530-539.
[8] 潘爱星,海涌,杨晋才,等.棘突间动态稳定术治疗腰椎管狭窄症的长期随访研究[J].中国骨与关节杂志,2018,1(2):33-36.
[9] 张国旺,徐建广.棘突间动态固定系统防治椎间融合术后相邻节段退变中期疗效观察[J].中国骨与关节杂志,2018,7(2):98-102.
[10] 王振林,黄培培,焦海斌,等.Wallis与融合治疗腰椎管狭窄症的中期疗效及对相邻节段退变影响的对比观察[J].中国矫形外科杂志,2016,24(1):24-29.
[11] 张杰超,张子峰,汤伟忠.腰椎Wallis系统的应用及术后相关研究进展[J].医学综述,2016,22(15):2975-2977.
[12] Kamson S,Trescot AM,Sampson PD,et al.Full-endoscopic assisted lumbar decompressive surgery performed in an outpatient,ambulatory facility:report of 5 years of complications and risk factors[J].Pain Physician,2017,20(2):E221-E231.
[2] Rao PJ,Loganathan A,Yeung V,et al.Outcomes of anterior lumbar interbody fusion (ALIF) surgery based on indication:a prospective study[J].Neurosurgery,2015,76(1):7-23.
[3] Phan K,Mobbs RJ.Oblique lumbar interbody fusion for revision of non-union following prior posterior surgery:a case report[J].Orthop Surg,2015,7(4):364-367.
[4] 海涌,孟祥龙,李冬月,等.腰椎棘突间动态稳定系统治疗腰椎滑脱症的临床疗效[J].中华外科杂志,2017(3):208-213.
[5] 肖筱武,罗继,高林,等.经后路手术减压治疗肥胖病患者腰椎管狭窄症的临床疗效观察[J].中国现代手术学杂志,2013,17(2):136-138.
[6] 邓勇,向静.腰椎后路动态稳定系统修复退行性腰椎椎管狭窄:疗效及安全性分析[J].中国组织工程研究,2018,22(15):2333-2339.
[7] Pan Z,Yoon H,Yi S,et al.Efficacy of transforaminal endoscopic spine system (TESSYS) technique in treating lumbar disc herniation[J].Med Sci Monit,2016,22(2):530-539.
[8] 潘爱星,海涌,杨晋才,等.棘突间动态稳定术治疗腰椎管狭窄症的长期随访研究[J].中国骨与关节杂志,2018,1(2):33-36.
[9] 张国旺,徐建广.棘突间动态固定系统防治椎间融合术后相邻节段退变中期疗效观察[J].中国骨与关节杂志,2018,7(2):98-102.
[10] 王振林,黄培培,焦海斌,等.Wallis与融合治疗腰椎管狭窄症的中期疗效及对相邻节段退变影响的对比观察[J].中国矫形外科杂志,2016,24(1):24-29.
[11] 张杰超,张子峰,汤伟忠.腰椎Wallis系统的应用及术后相关研究进展[J].医学综述,2016,22(15):2975-2977.
[12] Kamson S,Trescot AM,Sampson PD,et al.Full-endoscopic assisted lumbar decompressive surgery performed in an outpatient,ambulatory facility:report of 5 years of complications and risk factors[J].Pain Physician,2017,20(2):E221-E231.