置入棘突间稳定系统Wallis治疗腰椎退变性疾病:与单纯腰椎管减压的比较

Wallis interspinous dynamic stabilization in treating lumbar degenerative disease:A comparison with lumbar spinal canal decompression

背景:在早期,腰椎间盘退变性疾病的治疗临床常用髓核摘除或髓核摘除加刚性内固定融合技术,但是随着非刚性固定技术的发展,棘突间稳定系统固定和全椎间盘置换在脊柱非融合治疗中逐渐受到人们的重视,其优点日益突出。目的:与单纯腰椎管减压相比,评价腰椎管减压并棘突间稳定系统Wallis置入固定治疗腰椎退变性疾病的效果。方法:选择2007-12/2008-12华中科技大学附属同济医院骨科收治的腰椎退变性疾病患者40例,随机选取20例行单纯髓核摘除(对照组),20例行突出髓核摘除加棘突间稳定系统Wallis固定(实验组)。分别于置入后1周,1年对两组患者分别进行JOA评分、目测类比评分。结果与结论:两组患者置入后1周JOA评分及目测类比评分差异均无显著性意义(P>0.05);术后1年JOA评分及目测类比评分差异均有显著性意义(P<0.05)。提示两术式即刻效果无差异,均取得良好的效果,此效果主要依赖于手术有效的减压。实验组中期效果明显优于乙组,主要是棘突间稳定系统Wallis发挥良好的生物学作用,有效缓解了患者残余的慢性下腰痛。

BACKGROUND：Lumbar degenerative disease has been commonly treated with nucleus pulposus extirpation or nucleus pulposus extirpation combined with internal fixation;however,with the development of non-rigidity fixation,interspinous dynamic stabilization and intervertebral disk displacement attract more and more attention. OBJECTIVE：To evaluate the therapeutic effect of Wallis interspinous dynamic stabilization on lumbar degenerative disease compared with lumbar spinal canal decompression. METHODS：A total of 40 patients with lumbar degenerative disease were selected from Department of Orthopedic Surgery,Tongji Hospital,Tongji Medical College of Huazhong University of Science and Technology between December 2007 and December 2008.Twenty patients were treated with nucleus pulposus extirpation alone,considering as control group;while,other 20 patients were treated with nucleus pulposus extirpation combined with Wallis interspinous dynamic stabilization,considering as experimental group.JOA score and VAS score were made at 1 week and 1 year postoperatively for all the patients. RESULTS AND CONCLUSION：There was no significant difference in JOA score and VAS score between two groups at 1 week postoperatively（P 0.05）;but there was significant difference in both scores at 1 year postoperatively（P 0.05）.The results demonstrated that both methods achieved well therapeutic effects,which depended on effective decompression.The therapeutic effect of the first group was better than the second group,depending on the favourable biologic effect of the implantation of Wallis interspinous dynamic stabilization,which could effectively relieve the residual low back pain.