Wallis棘突间动态稳定系统治疗腰椎退行性疾病的中期疗效分析

Medium-term Curative Effect of Wallis Interspinous Dynamic Stabilization System for Treatment of Lumbar Spinal Degenerative Disease

目的分析Wallis棘突间动态稳定系统治疗腰椎退行性疾病的临床疗效,并结合文献探讨其潜在的问题。方法2009~2011年收治的60例腰椎退行性疾病患者,其中男性36例,女性24例,平均年龄43.2岁,32例以Wallis棘突间动态稳定系统进行治疗（Wallis组）,28例采用髓核摘除加脊柱内固定术（内固定组）。所有患者术前及术后进行脊髓功能评分（JOA）、疼痛视觉模拟评分（VAS）,同时测量病变节段及邻近节段手术前后的活动范围（ROM）和椎间高度（DH）。结果所有患者随访3~5年（平均38.3个月）。Wallis组JOA评分术前（13.3±0.3）分,术后（21.9±4.3）分;VAS评分术前（6.3±2.5）分,术后（1.6±0.4）分。内固定组JOA评分术前（12.8±0.5）分,术后（19.8±2.9）分;VAS评分术前（7.3±0.5）分,术后（1.8±0.6）分。术前两组患者手术及邻近节段DH及ROM无统计学差异。末次随访时内固定组手术节段ROM为0°,Wallis组手术节段ROM为（7.5±2.7）°,两组差异具有统计学意义（P〈0.01）;内固定组上端邻近节段ROM明显增加,大于Wallis组（P〈0.01）,说明Wallis组较好地保留了邻近节段运动功能。所有患者均未出现脑脊液漏、感染、棘突骨折、神经损伤、椎间盘突出复发、植入物移位等并发症,除2例患者术后3~5年腰痛复发外（Wallis组）,其余症状均无复发。结论 Wallis棘突间动态稳定系统作为一种新的脊柱非融合技术,克服了传统的脊柱融合术的缺陷,改善症状明显,治疗效果肯定,同时也存在一些潜在的问题需要解决。

Objective To explore the clinical efficacy of the Wallis dynamic stabilization system for the treatment of lumbar degenerative disorders,and discuss the potential problems by reviewing literatures.Methods A total of 60 patients with lumbar degenerative disease were treated with the Wallis system from 2009 to 2011,including 36 males and 24 females,with an average age of 43.2years.Thirty-two patients were treated with Wallis interspinous dynamic stabilization（Wallis group）and the other28 patients with removal of nucleus pulposus and spinal implant operation（internal fixation group）.The clinical efficacy was evaluated with spinal cord function score（JOA）and the visual analogue scale（VAS）before and after operation.The range of motion（ROM）and disc height（DH）of diseased segments and upper or lower adjacent segments were measured before and after operation.Results All the patients were followed up for 3to 5years with an average of 38.3months.In the Wallis group,JOA score was（13.3±0.3）before the operation and（21.9±4.3）after the operation;VAS score was（6.3±2.5）before surgery,and（1.6±0.4）after surgery.In the internal fixation group,JOA score was（12.8±0.5）before surgery,and（19.8±2.9）after surgery;preoperative VAS score was（7.3±0.5）and postoperative VAS score was（1.8±0.6）.There was no significant difference in preoperative ROM and DH in diseased segments and adjacent segments between the two groups.The ROM of the fixed segments was reduced to 0°in last follow-up in the internal fixation group,while it was（7.5±2.7）°in Wallis group,with the difference being statistically significant（P〈0.01）.The ROM of the upper adjacent segments was increased significantly in internal fixation group,significantly higher than that in Wallis group（P〈0.01）,which indicated that the Wallis system is superior to the internal fixation in terms of retaining motor function of adjacent segments.No patient experienced cerebrospinal fluid leakage,postoperative infection,spinous process fracture,nerve damage,recurrent disc herniation,implant displacement and other complications,and there was no recurrence of symptoms except 2cases of postoperative low back pain after 3to 5years in Wallis group.Conclusion Wallis dynamic stabilization system,as a new kind of spinal non-fusion technology,overcomes the defect of traditional spinal fusion,improves symptoms and achieves satisfactory clinical efficacy.However,there are some potential problems that need to be solved.