棘突间动态稳定装置Wallis治疗腰椎退行性疾病中长期随访效果分析

Intermediate and long-term follow-up evaluation of posterior dynamic lumbar stabilization in lumbar degenerative disease

目的探讨棘突问动态稳定装置Wallis治疗腰椎退行性疾病的中长期效果。方法回顾性分析2007年8月至2010年1月采用Wallis或结合固定融合方法治疗腰椎退行性疾病并有2年以上随访的96例患者资料，其中男性51例，女性45例；年龄21～68岁，平均41．5岁。采用疼痛视觉模拟量表（VAS）100分法和中华医学会骨科分会脊柱外科学组腰椎手术疗效标准评估手术短期和中长期疗效，测量分析术前、术后3个月和末次随访时Wallis植入节段椎间盘终板高度，随访有无Wallis相关并发症及患者对手术的满意度，部分患者MRI检查分析Wallis植入节段术后椎间盘影像学变化。结果术前、术后3个月及末次随访疼痛VAS评分分别为78±24、28±16和14±12，采用配对t检验，术后3个月及末次随访疼痛VAS评分较术前明显下降（t=2．634和2．653，P〈0．01）；末次随访疼痛VAS评分较术后3个月也有下降（t=2．147，P〈0．05）。术后末次随访功能恢复优良率为91．7％，患者手术整体满意率为95．8％，术前、术后3个月和末次随访时Wallis植入节段椎间盘终板高度分别为（8．2±3．7）、（10．4±2．6）和（10．1±1．9）mm，MRI检查未发现植入节段间盘退变加速、部分患者可见椎间盘水化。结论棘突间动态稳定装置Wallis或结合固定融合方法治疗腰椎退行性疾病简便安全，2年以上中长期随访疗效良好，为腰椎退行性疾病的手术治疗增加了一种新的选择。

Objective To evaluate the intermediate and long-term follow-up effect of posterior dynamic lumbar stabilization in lumbar degenerative disease. Methods The clinical outcomes of 96 patients （male 51 ,female 45, age from 21 to 68 years, mean 41.5 years） whose follow-up time were more than 2 years with lumbar degenerative disease treated by posterior decompression with Wallis posterior dynamic lumbar stabilization implant or combined with posterior lumbar fusion from August 2007 to January 2010 were retrospectively studied, and assessed with visual analogue scale （VAS） and spinal operative standard of Chinese Medical Association. The early and long-term follow-up effect and complications associated with Wallis posterior dynamic lumbar stabilization were recorded. The height of intervertebral space at the treated level in lateral plain fihn were measured at preoperatively, 3 month postoperatively and last follow-up, respectively. The finds of MRI obtained at over 6 month postoperative were recorded. Results The operative procedure of Wallis posterior dynamic lumbar stabilization implant was easy and less invasive. The VAS scores were 78±24, 28 ± 16 and 14±12 preoperatively, 3 month postoperatively and last follow-up, respectively. The good or excellent result was 91.7% at the last follow-up. No complication related with Wallis posterior dynamic lumbar stabilization was found. The rate of patient＇s satisfaction with the Wallis implant operation was 95.8%. The disc height at the treated level in lateral plain film were （8.2±3.7） , （ 10.4 ±2. 6 ） and （ 10. 1 ± 1.9 ） mm at preoperatively, 3 month postoperatively and last follow-up, respectively. There is no further degenerative change found in MRI obtained at over 6 month postoperative. MRI 1 year after Wallis procedure showed rehydration of the formerly black disc at the treated level. Conclusions It is easy and safe to use Wallis posterior dynamic lumbar stabilization in treatment of degenerative lumbar disease, and the effect of the intermediate and long-term follow-up more than 2 years is good. The Wallis system provides an alternative for treatment of lumbar degenerative disease.