棘突间固定系统治疗腰椎退变性疾患的短期临床随访

Retrospective study of application of interspinous implants for degenerative lumbar diseases

目的探讨腰椎棘突问固定系统临床应用的适应征选择及临床效果。方法2007年9月至2008年9月期间68例腰椎退变性疾患病例应用棘突间固定系统，采用腰痛VAS评分，下肢痛VAS评分，腰椎JOA评分（29分法）评定临床症状改善情况；采用Prolo腰椎功能评定标准评定术后功能改善情况；术后拍摄腰椎正侧位X线判定内固定物的位置、有无棘突骨折；测量术前和末次随访标准侧位片手术节段前凸角；末次随访拍摄腰椎过伸过屈位X线，测定手术节段活动度为过伸位前凸角．过屈位前凸角。结果64例病例获得完整随访，平均随访11．4个月，末次随访腰痛VAS评分（1．7±1．5）、下肢痛VAS评分（1．3±1．0）、腰椎JOA评分（23．5±3．1）和Prolo功能评分（8．6±1．4）；较术前腰痛VAS评分（4．9±3．3）、下肢痛VAS评分（7．2±2．8）、腰椎JOA评分（13．4±4．9）和Prolo功能评分（4．2±2．8）均有显著性改善（P〈0．01），末次随访手术节段前凸角（15．4±4．2）。较术前前凸角为（19．6±4．7）。明显降低（P〈0．01）；末次随访手术节段椎间活动度为（10．3±4．5）。；2例腰椎间盘突出患者术后半年内复发行二次手术。结论治疗腰椎退变性疾患应用棘突间固定系统仍然处于起步阶段，临床适应征的选择非常重要，短期的临床随访显示了其临床效果、安全性，也预示了良好的应用前景。

Objective To assess the indications, efficacy and safety of applying interspinous implants for degenerative lumbar diseases. Methods From September 2007 to September 2008, 68 cases with degenerative lumbar diseases were treated with interspinous implants. The clinical outcome was assessed by VAS of pain in back and lower extremities, lumbar JOA score and Prolo functional score ; the radiological results including implant position, segmental lodosis and segment movement degree were assessed by lumbar X ray including dynamic post-operative versus pre-operative X ray. Results Sixty-four cases had a complete follow-up and the average time was 11.4 months. At the final follow up, lumbar VAS 1.7±1.5, lower extremity VAS 1. 3± 1. 0, lumbar JOA score 23.5 ±3. 1 and Prolo functional score 8.6 ±1. 4. They were better than those at pre-operation （ 1.7 ±1.5, 1.3 ± 1.0, 23.5± 3.1, 8. 6± 1.4）. Segment lodosis angle （ 15.4 ±4. 2 ） ° was less than （ 19. 6 ± 4. 7 ） ° at pre-operation; segment movement degree was （ 10. 3± 4.5）°. Two cases with lumbar disc herniation relapsed and received a second operation. Conclusion The application of interspinous implants for degenerative lumbar diseases is still in its infancy and the selection of indication is very important. Its efficacy and safety have been confirmed by a short follow-up.