后路Waveflex非融合椎弓根螺钉弹性固定小开窗髓核摘除结合纤维环修复治疗青壮年腰椎间盘突出症的短期疗效

目的探讨腰椎后路Waveflex弹性固定小开窗髓核摘除联合纤维环缝合技术对青壮年腰椎间盘突出症(LDH)的短期疗效。方法采用回顾性研究,收集潍坊市人民医院和解放军第八十九医院2015年1月至2017年12月56例青壮年LDH患者的临床资料。根据治疗方法的不同,分为单一组(单一行髓核摘除治疗) 25例和联合组(腰椎后路Waveflex弹性固定小开窗髓核摘除联合纤维环修复技术) 31例。比较两组治疗前和治疗后6、12、18个月视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、日本骨科协会(JOA)下腰痛评分的变化情况。比较两组治疗前和末次随访(治疗后18个月)病变节段活动范围和椎间盘高度的改善情况,并随访并发症的发生情况。结果联合组治疗前和治疗后6个月VAS、ODI、JOA评分与单一组比较,均无显著差异(P>0.05);联合组治疗后12个月VAS明显低于单一组,JOA评分明显高于单一组(P<0.05);两组治疗后12个月ODI比较,并无显著差异(P>0.05);联合组治疗后18个月VAS和ODI评分均明显低于单一组,JOA评分明显高于单一组(P<0.05)。直至末次随访时,单一组治疗后18个月病变节段椎间盘高度低于治疗前(P<0.01),治疗前后病变节段活动范围比较,并无明显改变(P>0.05);联合组治疗后18个月病变节段椎间盘高度明显高于治疗前,病变节段活动范围低于治疗前(P<0.01);联合组治疗后18个月病变节段椎间盘高度明显高于单一组,病变节段活动范围明显低于单一组(P<0.01)。两组随访期间均未出现内固定松动、断裂或切口感染等不良情况。结论相比单一常规髓核摘除治疗,腰椎后路Waveflex弹性固定小开窗髓核摘除联合纤维环缝合技术可有效恢复青壮年LDH患者早期腰椎功能,改善病变节段的椎间盘高度和活动范围,提高脊柱稳定性,因此值得临床应用。

The short-term effect of waveflex in the treatment of lumbar disc herniation in young adults

Objective To investigate the short-term effect of waveflex elastic fixation with small fenestration and nucleus pulposus removal combined with fiber ring repair on lumbar disc herniation(LDH)in young adults.Methods A retrospective study was conducted to collect the clinical data of 56 young and middle-aged LDH patients in Weifang People’s Hospital and 89 th Hospital of PLA from January 2015 to December 2017.According to the different treatment methods,the patients were divided into the single treatment group(single nucleus pulposus removal,25 cases)and the combined treatment group(waveflex elastic fixation with small fenestration nucleus pulposus removal combined with fiber ring repair Technology,31 cases).The changes of visual analogue score(VAS),Oswestry dysfunction index(ODI)and Japanese Orthopaedic Association(JOA)scores were compared before and 6,12,18 months after treatment.The improvement of disease segmental movement and intervertebral disc height before and at the last follow-up(18 months after treatment)were compared between the two groups.Results There was no significant difference in VAS,ODI and JOA scores between the combined treatment group and the single treatment group before and 6 months after treatment(P>0.05);VAS of the combined treatment group was significantly lower than that of the single treatment group and JOA score was significantly higher than that of the single treatment group(P<0.05).There was no significant difference in ODI of the two groups after 12 months of treatment(P>0.05).VAS and ODI scores of the combined treatment group were significantly lower than those of the single treatment group after 18 months of treatment(P>0.05).The JOA score was significantly higher than that of the single treatment group(P<0.05).At the end of the follow-up,the height of the diseased segment intervertebral disc in the single group was lower than that before treatment(P<0.01),and there was no significant change in the movement range of diseased segment before and after treatment(P>0.05).The height of diseased segment intervertebral disc in the combined treatment group was higher than that before treatment,and the movement range of diseased segment was lower than that before treatment(P<0.01).The height of diseased segment intervertebral disc in the combined treatment group was higher than that in the single treatment group,and the the movement range of diseased segment was lower than that in the single treatment group(P<0.01).During the follow-up of the two groups,there were no adverse conditions such as loosening of internal fixation,fracture or incision infection.Conclusion Compared with single conventional nucleus pulpectomy,waveflex elastic fixation with small fenestration combined with fiber ring repair can effectively restore the early lumbar function,improve the intervertebral disc height and range of movement of the diseased segment,and improve the stability of the spine,so it is worthy of clinical application.