Wallis棘突间动态稳定系统治疗退变性腰椎间盘突出症32例

Wallis interspinous dynamic stabilization system in cure and prevention of lumbar degeneration and adjacent segment degeneration

目的研究棘突间动态稳定系统Wallis在治疗退变性腰椎间盘突出症和预防相邻节段退变（Adjacent segment degeneration,ASD）中的作用。方法选择2012年1月-2014年1月腰椎间盘突出症患者32例,在手术过程中行病变节段髓核摘除后安装棘突间动态稳定系统Wallis。观察手术时间、出血量、术后住院时间、术后并发症等。同时检测术前术后以下指标：1腰痛JOA评分;2腰痛VAS评分;3ODI评分;4腰椎病变节段及邻近节段活动范围（Rang e of motion,ROM）;5椎间盘高度（Discheight,DH）。综合分析相关数据。结果所有患者均获随访,随访时间15-24个月,平均19个月。出血量（53.8±26.3）m L,手术时间（73.3±32.5）分钟,Wallis置入时间为（26.3±6.7）分钟。VAS评分由术前的（8.1±1.8）分降至随访时的（2.2±1.2）分,JOA评分由术前的（8.1±1.6）分降至随访时的（2.2±1.4）分,ODI由术前的（61.3±9.5）%减至随访时的（22.3±9.1）%,术前与随访时JOA、VAS、ODI比较有统计学差异（P〈0.05）。手术节段DH由术前（8.6±2.1）mm增至随访时（9.2±2.5）mm,ROM由术前的（13.1±1.8）°减少至随访时为（7.9±1.5）°,两者术前与随访时比较,差异有统计学意义（P〈0.05）。但上下相邻节段的DH、ROM术前与随访时对比均无明显差异（P〉0.05）。结论 Wallis治疗退变性腰椎间盘突出症疗效显著。Wallis保留了手术节段的一定活动度,不增加邻近节段的活动度及退变发生率,对相邻节段的退变具有一定保护作用。

Objective The purpose of the study is to investigate the effect of Wallis interspinous dynamic stabilization system（IDSS）in prevention of lumbar degeneration and adjacent segment degeneration（ASD）.Methods The clinical data of 32 patients who were treated by Wallis IDSS between Jan 2012 and Jan 2014 were retrospectively analyzed.Observe the operation time,bleeding volume,postoperative hospital stay,postoperative complications.The following related indexes were detected before and after operation.1Japan Department of orthopedics association score.2Visual analogue scale.3Oswestry disability index.4The range of motion of the Lumbar adjacent segment.5Disc height.Comprehensive analysis of relevant data.Results The follow-up lasted for 19 months on average（range,15 to 24months） in all patients.Bleeding volume（53.8 ±26.3） m L,Operation time（73.3 ±32.5） min,Wallis Operation time（26.3 ±6.7）min.The postoperative VAS,JOA,ODI were significantly lower than preoperative ones（VAS：8.1±1.8vs 2.2±1.2,JOA：8.1±1.6 vs2.2±1.4.ODI：（61.3±9.5）% vs（22.3±9.1）%,P〈0.05）.The disc height of involved segments increased from（8.6±2.1） cm preoperatively to（9.2±2.5） cm at the last follow-up,and the ROM of involved segments decreased from（13.1±1.8） ° preoperatively to（7.9±1.5） ° at the last follow-up（P〈0.05）.But there were no significant differences in disc height and ROM of adjacent segments before surgery and at the last follow up（P〈0.05）.Conclusion Wallis IDSS is an effective technique in treatment of DLBP.Meanwhile,it can maintain the physiological activity of the involved vertebrae,and does not increase the stress of the adjacent segments and the incidence of degeneration.