Wallis棘突间动态稳定系统治疗腰椎间盘突出症的长期疗效

Long-term results of Wallis interspinous dynamic stabilization system in the treatment of lumbar disc herniation

[目的]探讨应用Wallis棘突间动态稳定系统治疗腰椎间盘突出症术后平均8.1年的临床疗效。[方法]回顾性分析2008年7月~2010年7月本科应用Wallis系统治疗的79例腰椎间盘突出症患者,收集术前、术后4年及末次随访临床及影像学资料,统计椎间盘再突出、内固定失败等相关远期并发症。[结果]79例患者中51例获得连续性随访6.3~9.3年,平均(8.14±1.12)年。术后4年和末次随访时腰痛和腿痛VAS、JOA和ODI评分均较术前明显改善,差异有统计学意义(P<0.001),但术后4年和末次随访时上述指标的差异无统计学意义(P>0.05)。术前、术后4年和末次随访时,中立位和过屈位测量的手术节段、头端和尾端邻近节段的Cobb角、椎间盘高度无明显变化(P>0.05)。在过伸位,手术节段Cobb角和ROM减小,而邻近节段Cobb角和ROM增加,差异有统计学意义(P<0.05)。与术前对比,末次随访时Pfirrmann.s分级显示手术节段总的改善率为33.33%,无明显改变率为56.86%,退变加重率为9.81%;而头尾端邻近节段椎间盘无明显差异。末次随访时1例患者椎间盘突出复发,无其他远期并发症。[结论]应用Wallis棘突间动态稳定系统治疗腰椎间盘突出症术后8.1年随访效果良好,具有潜在的椎间盘保护作用,对邻近节段干扰影响小。

[Objective] To explore the clinical outcomes of Wallis interspinous dynamic stabilization system for treatment of lumbar disc herniation at an average of 8.1 years after operation. [Methods] A retrospective study was done on a total of 79 patients who underwent surgical treatment with Wallis system for lumbar disc herniation in our department from July 2008 to July 2010. The consequences, including radiographic measurements, failure of internal fixation and other related long-term complications were evaluated at 4 years after operation and the latest follow-up. [Results] Of the 79 patients, 51 patients were consecutively followed up for an average of（8.14±1.12） years ranged from 6.3 to 9.3 years. The VAS of lower back pain and leg pain, as well as JOA and ODI score were significantly improved at 4 years after operation and the latest follow-up compared those before operation（P〈0.05）, although no significant differences in any aforesaid parameters were noticed between the data at 4 years and those at the latest follow-up（P〈0.05）. In term of radiologic measurement, Cobb angles and ROM of the operated segment as well as the cephalic and caudal adjacent segments at the neutral position and the extremely flexion position kept unchanged significantly at time points before operation, 4 years after operation and the latest follow up（P〈0.05）. However, the Cobb angles and ROM of the operated segment at the extremely extension position significantly decreased after operation（P〈0.05）, whereas those of the cephalic and caudal adjacent segments at the extremely extension position significantly increased over time（P〈0.05）. In addition, the Pfirrmann.s grades of intervertebral disc of the operated segment at the final followup were improved in 33.33%, unchanged in 56.86% and worsened in 9.81%, by contrast, which were no significantly altered in the cephalic and caudal adjacent segments. At the latest follow up, only one patient got recurrence of disc herniation, the remaining patients had no other long-term complications.[Conclusion] Wallis interspinous dynamic stabilization system for the treatment of lumbar disc herniation does achieve satisfactory clinical outcomes at 8.1-year follow-up on average, with advantages of protective effect on intervertebral disc and minimized impact on the adjacent segments.