BacFuse固定融合术治疗老年腰椎退行性滑脱

BacFuse interspinous implant for treatment of degenerative lumbar spondylolisthesis in the elderly

[目的]探讨BacFuse固定融合术治疗老年腰椎退行性滑脱的中短期临床疗效。[方法]回顾性分析2014年1月~2015年6月应用BacFuse固定融合术治疗的老年腰椎退行性滑脱症患者临床资料。共32例患者纳入研究,平均年龄(67.3±5.1)岁,平均随访(15.6±5.0)个月。Ⅰ度滑脱29个节段,Ⅱ度滑脱11个节段。临床疗效评估包括视觉模拟量表(VAS)评估疼痛情况,功能障碍指数(ODI)和日本骨科协会评分(JOA)评估功能情况;在X线片中测量椎间盘后缘高度(PDH)、椎间孔高度(FH)、手术节段活动范围(ROM)和上下椎体间的相对位移。[结果]本组平均手术时间(55.0±12.4)min。VAS评分由术前的(6.75±1.39)分降至末次随访的(2.41±1.78)分、ODI评分由术前的(35.47±11.15)分降至(13.22±7.66)分,JOA评分从(12.25±1.52)分增至(24.16±3.46)分;PDH由(6.75±2.43)mm增至末次随访的(8.44±2.56)mm、FH由(19.98±3.34)mm增至末次随访的(21.72±2.74)mm、手术节段活动范围(ROM)由(15.95±4.31)°降至末次随访的(3.75±1.36)°、上下椎体间的相对位移由(5.02±0.93)mm降至末次随访的(0.35±0.27)mm。[结论]BacFuse棘突间固定融合术治疗老年腰椎退行性滑脱症,具有手术时间短、出血少、疗效好、并发症少等优点,对高龄患者是一个安全有效的手术方式。

[Objective] To investigate the short-medium term clinical outcome of the BacFuse interspinous implantation for treatment of the degenerative lumbar spondylolisthesis in the elderly. [nethods] From January 2014 to June 2015, 32 patients with degenerative lumbar spondylolisthesis were surgically treated with BacFuse interspinous implantation, including 15 males and 17 females with a mean age of （67.3±5.1） years. In them, Grade I of spondylolisthesis was found in 29 segments while Grade Ⅱ in Ⅱ segments. Pre- and postoperatively, the VAS, ODI and JOA were used to assess clinical symptom and physical function. The posterior disk height, foraminal height, range of motion and the relative displacement between the upper and lower vertebral body were measured in X-ray film. [Results] The operation lasted （55.0±1.2.4） minutes with blood loss of （49.8±19.9） ml on average without severe surgical complication . All the patients were followed up for an average of （ 15.6±5.0） months. At the latest follow-up, VAS significantly decreased from （6.75± 1.39） preoperatively to （2.41±1.78） （P〈 0.05） , likewise ODI considerably decreased from （35.47±11.15） to （13.22±7.66） （P〈0.05） , whereas the JOA statistically increased from （12.25± 1.52） to （24.16±3.46） （P〈0.05） . In term of radiographic measurements, the posterior disk height significantly increased from （6.75±2.43） mm to （8.44_＋2.56） mm （P〈O.05） , the foraminal height increased from （19.98±3.34） mm to （21.72±2.74） mm （P〈0.05） , whereas the range of motion in ＇affected segments decreased from （ 15.95±4.31 ）°to （3.75± 1.36）° （P〈0.05） , additionally, the relative displacement between the upper and lower vertebral body decreased from （5.02±0.93） mm to （0.35±0.27） mm （P〈0.05） . [Conclusion] BacFuse interspinous implantation for treatment of the degenerative lumbar spondylolisthesis with advantages of shortened operation time, diminished blood loss, and reliable out- come, is a safe surgical procedure for the elderly.