棘突间固定融合装置BacFuse在退行性腰椎滑脱症的临床疗效分析

Analysis on the Clinical Efficacy of Inter-Spinal Fusion Device(BacFuse)in Degenerative Lumbar Spondylolisthesis

目的探讨BacFuse治疗退行性腰椎滑脱症的临床疗效。方法分析某医院2015年8月1日-2018年8月31日期间住院接受BacFuse手术治疗的36例退行性腰椎滑脱症的患者,其中男性11例,平均年龄(68.6±7.3)岁,女性25例,平均年龄(67.8±8.3)岁。Ⅰ度滑脱患者30例,Ⅱ度滑脱患者6例;单节段患者27例,双节段患者9例。术后随访时间分别为术后1个月、术后6个月、术后2年,采用视觉模拟评分及Oswestry功能障碍指数进行疗效评估。采用椎间盘后缘高度、椎体滑脱程度、椎间隙活动范围、椎体的过屈角度及椎体的过伸角度进行影像学评估。结果本组患者的VAS评分由术前的(5.67±0.99)分降至末次随访的(2.19±1.17)分(P<0.001);ODI评分由术前的(32.41±4.09)分降至(11.98±5.60)分(P<0.001);影像学评估PDH由术前的(0.484±0.18)厘米升至术后末次随访的(0.716±0.25)厘米(P<0.001),SD由术前的(6.214±4.30)厘米降至(2.483±3.03)厘米(P<0.001);FA由术前的(4.164±4.79)度降至(3.959±3.88)度(P>0.05);EA由术前的(10.378±4.87)度降至(6.44±4.99)度(P<0.001);ROM由术前的(6.214±4.30)度降至(2.483±3.03)度(P<0.001)。结论对于Ⅰ度退行性腰椎滑脱的患者,BacFuse棘突间固定融合术是一种可行的治疗方法,能够改善患者症状,并且手术时间短,损伤小,并发症少,可作为退行性腰椎滑脱的阶段治疗方案,从而延缓甚至避免行钉棒手术。

Objective To investigate the clinical efficacy of BacFuse in the treatment of degenerative lumbar spondylolisthesis.Methods 36 patients with degenerative lumbar spondylolisthesis who received BacFuse operation in Beijing Friendship Hospital from August 1,2015 to August 31,2018 were analyzed retrospectively.There were 11 males with an average age of 68.6±7.3 years and 25 females with an average age of 67.8±8.3 years.There were 30 patients withⅠ°spondylolisthesis,6 patients withⅡ°spondylolisthesis,27 patients with single segmental spondylolisthesis and 9 patients with double segmental spondylolisthesis.The postoperative follow-up time was 1 month,6 months and 2 years after operation,respectively.The curative effect evaluation included:visual analogue scale,VAS,Oswestry disability index,ODI.Image evaluation includes:Posterior disc height,PDH;slip distance,of vertebral SD;range of motion of intervertebral space,ROM;flexion angle of vertebral body,FA;overextension angle of vertebral body,EA.Results The VAS score decreased from 5.67±0.99 before operation to 2.19±1.17 at the last follow-up(P>0.001);ODI score decreased from 32.41±4.09 before operation to 11.98±5.60 at last follow-up(P<0.001).Imaging evaluation:PDH increased from(0.484±0.18)cm before operation to last follow-up(0.716±0.25)cm(P<0.001),SD decreased from(6.214±4.30)cm to(2.483±3.03)cm(P<0.001);FA decreased from(4.164±4.79)°to(3.959±3.88)°(P>0.05).EA decreased from(10.378±4.87)°to(6.44±4.99)°(P<0.001);ROM decreased from(6.214±4.30)°to(2.483±3.03)°(P<0.001).Conclusion For patients with I°degenerative lumbar spondylolisthesis,BacFuse interspinous process fixation fusion is a feasible treatment method,which can significantly improve the symptoms,and has the advantages of short operation time,less injury and less complications,so it can be used as a First treatment for degenerative lumbar spondylolisthesis,thus delaying or even avoiding PLIF surgery.