摘要
目的评价棘突间动态稳定装置Wallis治疗腰椎退行性疾病的中短期疗效，并对术后存在问题进行总结分析。方法回顾性分析2009年1月至2010年6月收治的单节段腰椎间盘突出症伴或不伴腰椎管狭窄症的48例患者资料，其中男性30例，女性18例；年龄17～69岁，平均43岁。患者均行椎管开窗减压及Wallis棘突间置入术治疗，手术节段：L3～4例，L4-5，38例，L5～S1 6例。通过随访术前、术后腰腿痛视觉模拟量表（VAS）评分、Oswestry功能障碍指数（ODI）评分评估其临床症状改善情况，评估影像学变化。结果患者术后均未发生手术相关并发症。术后随访12—30个月，平均（20±4）个月。ODI评分从术前46±10下降到末次随访时的24±7（t=12．765，P〈0．05），腰腿痛VAS评分从术前平均8．1±1．6下降到末次随访时的2．1±1．1（t=21．881，P〈0．05）。6例患者于术后2～13个月出现椎间盘突出复发（6／48，12．5％），且均为L4-5，节段；3例接受椎间盘切除及椎间融合术，另外3例保守治疗，症状均明显缓解。结论Wallis治疗腰椎退行性疾病总体上中短期效果满意，能够显著缓解腰腿痛症状，但仍存在术后复发等问题。
Objectives To review degenerative lumbar disease treated with Wallis and the re-herniation cases after the implantation of Wallis, so as to evaluate the effect of the device. Methods From January 2009 to June 2010, a retrospective analysis was done and 48 patients （30 males and 18 females） with an average age of 43 years（ranging from 17 to 69 years） ,who received stabilization of the segment using the Wallis device, were reviewed. The involved segments included： 4 cases at L34,38 cases at L4_5,6 cases at L5-S1. Preoperative and postoperative visual analogue scales （VAS） and Oswestry disability index （ODI） were recorded to evaluate the clinical efficiency, imageology diversity was assessed by X-rays and MRI. Results All cases received fenestration and the implantation of Wallis. No surgery related complications were recorded. There were 48 cases were followed up. The average follow-up period was （20 ± 4） months （ 12-30 months）. The average ODI score dropped from 46±10 to 24 ±7 （ t = 12. 765, P 〈 0. 05）. The average VAS for back and leg pain dropped from 8.1 ± 1.6 to 2. 1± 1.1 （t = 21. 881 ,P 〈 0. 05 ）. Six patients with recurrent lower back and leg pain were diagnosed by MRI, as recurrent herniation （6/48,12. 5% ）. All re-herniation occurred at L4_5 level, between 2 and 13 months after the surgery. Three of the 6 patients underwent additional disceetomy and fusion, others received conservative treatment. Conclusions Although existing problems such as recurrence after surgery, the clinical outcome of Wallis in treating protrusion of lumbar intervertebral disc and lumbar stenosis is satisfied in middle-early stage.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2012年第9期788-791,共4页
Chinese Journal of Surgery
关键词
腰椎
椎间盘
椎间盘移位
椎管狭窄
内固定器
假体和植入物
复发
Lumbar vertebrae
Intervertebral disk
Intervertebral disk displacement
Spinal stenosis
Internal fixators
Prostheses and implants
Recurrence
