腰椎棘突间动态辅助运动系统治疗腰椎退变性疾病临床疗效分析

目的 探讨腰椎棘突间动态辅助运动(dynamic interspinous assisted motion,DIAM)系统治疗腰椎疾患的疗效.方法 2006年6月至2008年1月,采用腰椎DIAM治疗8例腰椎不稳症患者.年龄40～52岁,平均46.9岁;女6例,男2例.术后行腰椎正、侧位X线检查.术后3个月、半年、1年及末次随访时行腰椎正、侧位及动力位X线检查,选用Oswestry功能障碍指数(Oswestry disability index,O-DI)和视觉模拟评分法(visual analogue scale,VAS)对手术效果进行评价.结果 术后随访12～31个月,平均20.6个月.术前、术后3个月、半年、1年及末次随访时的ODI评分分别为67.75±12.12、22.25±15.76、19.75±17.12、20.00±18.48与23.00±19.09,VAS评分分别为8.44±1.35、2.88±3.41、2.63±3.51、2.50±3.78与3.50±4.15.术前与术后各时间段的ODI、VAS评分差异有统计学意义(P＜0.05),术后各时间段间评分差异则无统计学意义(P＞0.05).术前、术后3个月、半年、1年及末次随访时手术节段(L4,5)活动度分别为10.38°±5.13°、4.25°±2.19°、2.63°±0.92°、2.00°±0.86°与2.13°±1.55°,术前与术后各时间段活动度的差异有统计学意义(P＜0.05),术后各时间段间差异无统计学意义(P＞0.05).ODI、VAS评分的改善与手术节段活动度有相关性(r＞0.7,P＜0.05).结论 DIAM系统作为一种新的治疗方法,在病例选择合适的情况下,可以获得良好的短期临床疗效,其长期疗效还有待进一步临床随访观察.

Clinical efficacy of dynamic interspinous assisted motion system in treatment of degenerative lumbar disease

Objective To investigate clinical efficacy of dynamic interspinous assisted motion(D1-AM)system in treatment of degenerative lumbar disease.Methods Eight cases with lumbar vertebral insta-bility were treated with the DIAM system at Peking Union Medical College Hospital from June 2006 to Jan-uary 2008.There were 6 female and 2 male cases,with a mean age of 46.9 years ranging from 40 to 52years.Radiographs and scores on outcome measures including the visual analogue scale(VAS)for pain and Oswestry Disability Index(ODI)were recorded before surgery and at 3-month,6-month,1-year intervals and final follow-up after surgery.Results The follow-up time ranged from 12 to 31 months,with the mean of20.6 months.The ODI scores before surgery and at 3-month,6-month,1-year intervals and final follow-up af-ter surgery were 67.75±12.12,22.25±15.76,19.75±17.12,20.00±18.48 and 23.00±19.09,while VAS seores were 8.44±1.35,2.88±3.41,2.63±3.51,2.50±3.78 and 3.50±4.15,respectively.There were significant differ-ence between preoperative ODI and VAS scores and postoperative ones(P＜0.05); however no difference was found at the different postoperative follow-up time(P＞0.05).The L4,5 segment activity were 10.38°±5.13°,4.25°±2.19°,2.63°±0.92°,2.00°±0.86°and 2.13°±1.55°,respectively.There were significant difference be-tween preoperative L4,5 segment activity and postoperative ones(P＜0.05); however no difference was found at the different postoperative follow-up time(P＞0.05).The ODI and VAS score improvements were directly cor-related with segment activity(r＞0.7,P＜0.05).Conclusion The DIAM system appears to be a useful and ef-fective alternative in the surgical management of degenerative lumbar disease if the patients are correctly selected.However long-term follow-up is needed to evaluate clinical outcomes of the device.