髓核摘除联合棘突间动态稳定内固定系统治疗腰椎间盘突出症的临床疗效

Clinical study of nucleus pulposus removal combined with interspinous dynamic stabilization & internal fixation system in the treatment of lumbar disc herniation

目的探讨髓核摘除联合棘突间动态稳定内固定系统治疗腰椎间盘突出症的临床疗效。方法选取2016年1月~2018年1月我院收治的42例腰椎间盘突出症患者为研究对象,采取髓核摘除联合Wallis棘突间动态稳定系统内固定治疗。比较术前、术后1、6、12个月时视觉模拟评分法评定疗效(VAS)、Oswestry功能障碍指数问卷表(ODI)及JOA腰痛疾患疗效评定标准,且经X线片检查比较术前、术后1、6、12个月时测量病变节段及相邻节段活动范围(ROM)与椎间盘高度(DH)。结果术后1、6及12个月时腰腿疼痛VAS评分明显优于术前,且术后12个月时明显优于术后1、6个月(均P<0.05)。术后1、6及12个月时ODI评分明显优于术前,且术后12个月时明显优于术后1、6个月(均P<0.05)。术后1、6及12个月时JOA评分明显优于术前,且术后12个月明显优于术后1、6个月(均P<0.05)。术后1、6、12个月时手术节段及邻近节段活动度明显低于术前(P<0.05);术后1、6、12个月时观察手术节段椎间盘高度明显低于术前(P<0.05),但邻近节段较术前无明显变化(P>0.05)。结论髓核摘除联合棘突间动态稳定内固定系统治疗腰椎间盘突出症,操作难度低,创伤小,可维持病变节段稳定性,短时间内可明显改善腰腿痛症状,提高腰部性能。

ObjectiveTo investigate the nucleus pulposus extraction combined with interspinous dynamic stabilization & internal fixation system in the treatment of lumbar disc herniation. Methods42 patients with lumbar disc herniation admitted in our hospital between January 2016 and January 2018 were selected to be treated with nucleus pulposus removal combined with Wallis interspinous dynamic stabilization system. Oswestry dysfunction index (ODI) questionnaire, JOA back pain evaluation criteria and visual analogue scale (VAS) were compared in 1 month, 6 months, and 12 months before and after surgery. The range of motion (ROM) and intervertebral disc height (DH) of the lesion stage and adjacent stage were measured by X-ray examination in 1 month, 6 months and 12 months before and after operation. Results The VAS score of postoperative lumbocrural pain was significantly better than that of the preoperative( P <0.05). The VAS score of postoperative lumbocrural pain was significantly decreased in 1 month, 6 months and 12 months, and the VAS score of postoperative lumbocrural pain in 12 months was significantly higher than that in 1 month and 6 months( P <0.05). The postoperative ODI score was significantly higher than the preoperative( P <0.05). The ODI score in 1 month, 6 months and 12 months was significantly decreased, and the postoperative ODI score in 12 months was significantly higher than that in 1 month and 6 months( P <0.05). The post-JOA score was significantly higher than that preoperative( P <0.05). The postoperative JOA score was significantly increased in 1 month, 6 months and 12 months, and the postoperative JOA score in 12 months was significantly higher than that in 1 month and 6 months( P <0.05). The postoperative ROM of surgical observation stage and adjacent segments in 1 month, 6 months, and 12 months was significantly lower than the preoperative( P <0.05). The intervertebral disc height (DH) of surgical observation stage and adjacent segments in 1 month, 6 months, and 12 months was significantly lower than the preoperative( P <0.05);there was no significant difference in the adjacent segments between before and after operation( P >0.05). ConclusionThere are few difficulties&trauma and complications in terms of nucleus pulposus extraction combined with interspinous dynamic stabilization & internal fixation system in the treatment of lumbar disc herniation, which can maintain the stability of the disease stage and significantly improve the symptoms of lumbocrural pain in a short time and improve the lumbar perfomance.