应用棘突间动态稳定系统治疗腰椎退变性疾病的疗效观察

Clinical outcomes of Wallis interspinous dynamic stabilization for lumbar degenerative disc disease

目的：探讨应用Wallis棘突间动态稳定系统治疗腰椎退变性疾病术后平均3.5年的临床效果。方法：回顾性分析2008年7月～2010年7月在我院行单节段椎板间开窗减压伴或不伴髓核摘除后棘突间置入Wallis系统治疗的79例腰椎退变性疾病患者。连续性随访获得术前、术后3个月及末次随访时的腰痛VAS评分、下肢痛VAS评分、JOA评分、ODI评分，X线片上测量术前、末次随访时的手术及上下邻近节段（即为手术节段、手术节段的上一位及下一位邻近节段）前凸角（Cobb角）及其屈伸活动度（ROM），MRI随访获得术前、末次随访时的手术及上下邻近节段椎间盘高度，并对椎间盘行改良Pfirrmann′s分级，计算其改善率。记录所有患者术中、术后手术相关并发症。结果：79例患者均为单节段置入Wallis系统，其中75例获得连续性随访，平均随访42.97±2.74个月（28～49个月），4例失访，未纳入本研究。所有患者术后症状明显改善，术后3个月及末次随访时的腰痛VAS评分、下肢痛VAS评分、JOA评分及ODI评分均较术前明显改善（P＜0.001），且末次随访时上述评分均较术后3个月明显改善（P＜0.001）；末次随访时手术节段过伸位Cobb角、ROM均较术前明显减小（P〈0.001），而上下邻近节段均较术前明显增大（P〈0.001），手术及上下邻近节段侧位和过屈位Cobb角与术前比较差异均无统计学意义（P〉0.05）；末次随访时手术节段椎间盘高度与术前比较稍增加（P〈0.001），而上下邻近节段椎间盘高度与术前比较差异均无统计学意义（P〉0.05）。术前与末次随访改良Pfirrmann′s分级对比显示：手术节段椎间盘总的改善率为45.3%，无明显改变的比率为52.1%，退变加重率为2.6%；而上下邻近节段无明显改善或加重，部分患者由Ⅲ级转为Ⅱ级。结论：应用Wallis棘突间动态稳定系统治疗腰椎退行性疾病术后平均3.5年随访效果满意。

Objectives： To explore a mean of 3.5-year clinical results of Wallis interspinous dynamic stabilization for lumbar degenerative disc disease. Methods： From July 2008 to July 2010, a retrospective analysis of 79 patients with lumbar degenerative disc disease who underwent one-level placement of the Wallis interspinous dynamic stabilization system was carried out, 75 of whom completed a mean of 3.5-year follow-up, Low back pain VAS, leg pain VAS, JOA and ODI score were measured at pre-operation, 3 months post-operation and final follow-up. The segmental lordosis and the cranial and caudal adjacent segment were evaluated by X-ray to understand their range of motion（ROM） and disc height, Pfirrmann′s classification under MRI was used to evaluate the disc degeneration. The intraoperative and postoperative complications of all patients were noted. Results： 79 cases with one-level Wallis placement were recorded, 75 of whom completed a mean of 42.97±2.74 months follow-up（range, 28-49 months）, and 4 lost follow-up. The preoperative symptoms of all patients relieved after operation. No complication such as recurrence or prosthesis displacement was noted. There were statistical differences in low back VAS score, leg VAS score, JOA score and ODI score at 3 months post-operation and final follow-up when compared with the preoperative data（P〈0.001） and the statistical difference existed between 3 months post-operation and final follow-up. At final follow-up, significant difference was noted as for the extension Cobb angle and ROM of the operated segment when compared with the pre-operation（P〈0.001）, while those in the cranial and caudal adjacent segments were bigger than the preoperative ones. There was no statistical difference in the lateral and flexion Cobb angle and ROM of the operated level as well as the cranial and caudal adjacent segment when compared with the pre-operation（P〉0.05）. At final follow-up, disc height of the operated segment was higher than the pre-operation（P〈0.001）, while there was no statistical difference as for the cranial and caudal adjacent segment（P〉0.05）. Pfirrmann′s classification at the pre-operation and final follow-up showed total improvement, no change, and deteriorate rate of 45.3%, 52.1% and 2.6% respectively, while there was no significant difference in the cranial and caudal adjacent segment when compared with those at pre-operation, some cases changed from grade Ⅲ to grade Ⅱ. Conclusions： Wallis interspinous dynamic stabilization system is an effective surgical option for the treatment of lumbar degenerative disc disease at least in a mean of 3.5-year follow-up.