棘突间弹性固定翻修术的原因分析
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摘要
[目的]分析棘突间弹性固定装置翻修手术的原因。[方法]2009年3月～2013年10月,11例接受棘突间弹性固定装置(Wallis或Coflex)手术的患者于2010年12月～2016年12月因多种原因行翻修手术,初次手术及翻修手术均在本科完成。其中包括9例男性和2例女性,初次手术平均年龄57岁(26～77岁)。对比分析两次术前及术后的临床资料及X线片、CT或MRI等影像学资料。[结果]两次手术平均间隔3.75年。通过对临床及影像资料的分析,翻修手术的可能原因包括:不恰当的手术适应证、相邻节段病、棘突骨折或骨吸收以及慢性感染。其中,不恰当的手术适应证又包括重度腰椎管狭窄症、明显的局部节段不稳定、腰椎侧弯及严重骨质疏松。[结论]棘突间弹性固定装置(Wallis或Coflex)不恰当的手术适应证包含重度腰椎管狭窄症、明显的局部节段不稳定、腰椎侧弯及严重骨质疏松。在棘突间弹性固定装置置入术后,相邻节段病、棘突骨折或骨吸收以及慢性感染的问题应得到关注。
[Objective] To explore the reasons of revision surgery after interspinous dynamic stabilization. [Methods] From Dec 2010 to Dec 2016, 11 patients who received interspinous dynamic stabilization(Wallis or Coflex implants) from Mar 2009 to Oct 2013 had revision surgery due to various reasons, as well as both the primary and revision surgeries were conducted in our department. Of them, 9 males and 2 females aged from 26 to 77 years with an average of 57 years at the primary surgery.The clinical and imaging data, such as X-ray, CT and MRI before and after both the primary and revision surgeries, were compared and assessed. [Results] The time spanned 3.75 years on average between the primary and revision surgeries. Based on clinical and imaging data, the reasons for revision surgery were deduced improper indication selection, adjacent segment disease, spinous fracture or bone resorption, and chronic infection. Among them, the improper indication selection was subdivided into severe lumbar spinal stenosis, obvious segmental instability, scoliosis and severe osteoporosis. [Conclusion] The improper indication selection of interspinous dynamic stabilization with Wallis or Coflex, such as severe lumbar spinal stenosis, obvious segmental instability, lumbar scoliosis and severe osteoporosis is the major reason of primary operation failure. In addition, the adjacent segment disease, spinous fracture or bone resorption and chronic infection secondary to the dynamic stabilization should be paid attention to.
[Objective] To explore the reasons of revision surgery after interspinous dynamic stabilization. [Methods] From Dec 2010 to Dec 2016, 11 patients who received interspinous dynamic stabilization(Wallis or Coflex implants) from Mar 2009 to Oct 2013 had revision surgery due to various reasons, as well as both the primary and revision surgeries were conducted in our department. Of them, 9 males and 2 females aged from 26 to 77 years with an average of 57 years at the primary surgery.The clinical and imaging data, such as X-ray, CT and MRI before and after both the primary and revision surgeries, were compared and assessed. [Results] The time spanned 3.75 years on average between the primary and revision surgeries. Based on clinical and imaging data, the reasons for revision surgery were deduced improper indication selection, adjacent segment disease, spinous fracture or bone resorption, and chronic infection. Among them, the improper indication selection was subdivided into severe lumbar spinal stenosis, obvious segmental instability, scoliosis and severe osteoporosis. [Conclusion] The improper indication selection of interspinous dynamic stabilization with Wallis or Coflex, such as severe lumbar spinal stenosis, obvious segmental instability, lumbar scoliosis and severe osteoporosis is the major reason of primary operation failure. In addition, the adjacent segment disease, spinous fracture or bone resorption and chronic infection secondary to the dynamic stabilization should be paid attention to.
引文
[1]Sénégas J,Vital JM,Pointillart V,et al.Long-term actuarial survivorship analysis of an interspinous stabilization system[J].Eur Spine J,2007,16(8):1279-1287.
[2]Sénégas J.Mechanical supplementation by non-rigid fixation in degenerative intervertebral lumbar segments:the Wallis system[J].Eur Spine J,2002,11(Suppl 2):164-169.
[3]Lindsey DP,Swanson KE,Fuchs P,et al.The effects of an interspinous implant on the kinematics of the instrumented and adjacent levels in the lumbar spine[J].Spine,2003,28(19):2192-2197.
[4]Kobayashi T,Atsuta Y,Takemitsu M,et al.A prospective study of de novo scoliosis in a community based cohort[J].Spine,2006,31(2):178-182.
[5]Aebi M.The adult scoliosis[J].Eur Spine J,2005,14(10):925-948.
[6]De Vries AA,Mullender MG,Pluymakers WJ,et al.Spinal decompensation in degenerative lumbar scoliosis[J].Eur Spine J,2010,19(9):1540-1544.
[7]Gurban CV,Mederle O.The OPG/RANKL system and zinc ions are promoters of bone remodeling by osteoblast proliferation in postmenopausal osteoporosis[J].Rom J Morphol Embryol,2011,52(3 Suppl):1113-1119.
[8]Dalle Carbonare L,Arlot ME,Chavassieux PM,et al.Comparison of trabecular bone microarchitecture and remodeling in glucocorticoid-induced and postmenopausal osteoporosis[J].J Bone Miner Res,2001,16(1):97-103.
[9]Sénégas J.Dynamic lumbar stabilization with the Wa Ilis interspinous implant[J].Interactive Surg,2008,3(4):221-228.
[10]Pan B,Zhang Z,Lu Y,et al.Biomechanical effects of an interspinous stabilization system(Wallis)on the lumbar spine[J].Chin J Exp Surg(Chin),2010,27(6):1642-1644.
[11]刘海鹰,周健,王波,等.Topping-off手术预防相邻节段退变加重的回顾性研究[J].中华外科杂志,2012,50(2):115-119.
[12]Panagiotis K,Thomas R,Spyros Z.Does Wallis implant reduce adjacent segment degeneration above lumbosacral instrumented fusion[J].Eur Spine J,2009,18(6):830-840.
[13]Justus R,Luft JH.A mechanochemical hypothesis for bone remodeling induced by mechanical stress[J].Calcif Tissue Res,1970,5(3):222-235.
[14]Takuma M,Tsutsumi S,Tsukamoto H,et al.The influence of materials difference on stress distribution and bone remodeling around alumina and titanium dental implants[J].J Osaka Univ Dent Sch,1990,30(30):86-96.
[15]Tanne K,Nagataki T,Matsubara S,et al.Association between mechanical stress and bone remodeling[J].J Osaka Univ Dent Sch,1990,30(30):64-71.
[16]Zupan J,Komadina R,Marc J.The relationship between osteoclastogenic and anti-osteoclastogenic pro-inflammatory cytokines differs in human osteoporotic and osteoarthritic bone tissues[J].J Biomed Sci,2012,19(1):1-10.
[17]Jerosch J,Moursi.Foreign body reaction due to polyethylene’s wear after implantation of an interspinal segment[J].Acta Orthop Trauma Surg,2008,128(1):1-4.
[18]Willert HG.Reactions of the articular capsule to wear products of artificial joint prostheses[J].J Biomed Mater Res,1977,11(2):157-164.
[2]Sénégas J.Mechanical supplementation by non-rigid fixation in degenerative intervertebral lumbar segments:the Wallis system[J].Eur Spine J,2002,11(Suppl 2):164-169.
[3]Lindsey DP,Swanson KE,Fuchs P,et al.The effects of an interspinous implant on the kinematics of the instrumented and adjacent levels in the lumbar spine[J].Spine,2003,28(19):2192-2197.
[4]Kobayashi T,Atsuta Y,Takemitsu M,et al.A prospective study of de novo scoliosis in a community based cohort[J].Spine,2006,31(2):178-182.
[5]Aebi M.The adult scoliosis[J].Eur Spine J,2005,14(10):925-948.
[6]De Vries AA,Mullender MG,Pluymakers WJ,et al.Spinal decompensation in degenerative lumbar scoliosis[J].Eur Spine J,2010,19(9):1540-1544.
[7]Gurban CV,Mederle O.The OPG/RANKL system and zinc ions are promoters of bone remodeling by osteoblast proliferation in postmenopausal osteoporosis[J].Rom J Morphol Embryol,2011,52(3 Suppl):1113-1119.
[8]Dalle Carbonare L,Arlot ME,Chavassieux PM,et al.Comparison of trabecular bone microarchitecture and remodeling in glucocorticoid-induced and postmenopausal osteoporosis[J].J Bone Miner Res,2001,16(1):97-103.
[9]Sénégas J.Dynamic lumbar stabilization with the Wa Ilis interspinous implant[J].Interactive Surg,2008,3(4):221-228.
[10]Pan B,Zhang Z,Lu Y,et al.Biomechanical effects of an interspinous stabilization system(Wallis)on the lumbar spine[J].Chin J Exp Surg(Chin),2010,27(6):1642-1644.
[11]刘海鹰,周健,王波,等.Topping-off手术预防相邻节段退变加重的回顾性研究[J].中华外科杂志,2012,50(2):115-119.
[12]Panagiotis K,Thomas R,Spyros Z.Does Wallis implant reduce adjacent segment degeneration above lumbosacral instrumented fusion[J].Eur Spine J,2009,18(6):830-840.
[13]Justus R,Luft JH.A mechanochemical hypothesis for bone remodeling induced by mechanical stress[J].Calcif Tissue Res,1970,5(3):222-235.
[14]Takuma M,Tsutsumi S,Tsukamoto H,et al.The influence of materials difference on stress distribution and bone remodeling around alumina and titanium dental implants[J].J Osaka Univ Dent Sch,1990,30(30):86-96.
[15]Tanne K,Nagataki T,Matsubara S,et al.Association between mechanical stress and bone remodeling[J].J Osaka Univ Dent Sch,1990,30(30):64-71.
[16]Zupan J,Komadina R,Marc J.The relationship between osteoclastogenic and anti-osteoclastogenic pro-inflammatory cytokines differs in human osteoporotic and osteoarthritic bone tissues[J].J Biomed Sci,2012,19(1):1-10.
[17]Jerosch J,Moursi.Foreign body reaction due to polyethylene’s wear after implantation of an interspinal segment[J].Acta Orthop Trauma Surg,2008,128(1):1-4.
[18]Willert HG.Reactions of the articular capsule to wear products of artificial joint prostheses[J].J Biomed Mater Res,1977,11(2):157-164.