棘突间动态稳定系统治疗腰椎退行性疾病的中期疗效分析

目的:探讨Wallis和Coflex棘突间系统治疗腰椎退行性疾病的中期临床疗效以及对邻近节段退变的影响。方法:对2011年1月至2013年1月应用棘突间固定系统治疗的L_(4,5)节段腰椎退行性疾病55例患者进行回顾性分析,其中男31例,女24例;年龄25～67岁,平均43.3岁;腰椎管狭窄症21例,腰椎间盘突出症34例。根据所采用的棘突间固定系统不同将患者分为Wallis组(33例)和Coflex组(22例)。采用视觉模拟评分(visual analogue scale,VAS)对腰痛和下肢痛进行评分;根据腰椎日本骨科协会(Japanese Orthopaedic Association,JOA)评分和Oswestry功能障碍指数(Oswestry Disability Index,ODI)评价腰椎功能;通过影像学资料测量手术前后手术节段和邻近节段活动度、椎间盘高度以及上位邻近节段Pfirrmann等级的变化情况。结果:55例患者均获得随访,随访时间48～72个月,平均60.4个月。术后48个月时,两组患者腰痛VAS评分、下肢痛VAS评分、腰椎JOA评分和ODI评分较术前有明显改善(P0.01),组间比较差异无统计学意义(P0.05);两组手术节段的活动度和椎间盘高度较术前均明显减小(P0.05),而上下邻近节段的活动度和椎间盘高度无明显变化(P0.05),两组间椎间隙高度和活动度比较无统计学意义(P0.05);两组患者上位邻近节段Pfirrmann分级较术前差异不明显(P0.05)。4例腰椎间盘突出症患者手术节段在术后1～3年复发,其中Wallis组3例,Coflex组1例,平均年龄35.2岁。结论:Wallis和Coflex系统治疗腰椎退变性疾病具有相同中期疗效,可延缓邻近节段退变,但不能阻止椎间盘突出的复发。

Mid-term follow-up efficacy of interspinous dynamic stabilization system for lumbar degenerative diseases

Objective: To explore mid-term clinical efficacy and effect on adjacent segment degeneration of Wallis and Coflex interspinous implants for lumbar degenerative diseases. Methods: From January 2011 to January 2013,55 patients with L_4,5 degenerative lumbar spine diseases treated with interspinous devices were retrospectively analyzed,including 31 males and 24 females aged from 25 to 67 years old with an average of 43.3 years old;21 patients were lumbar spinal stenosis and 34 patients were lumbar disc herniation. All patients were divided into Wallis group (33 cases) and Coflex group (22 cases) according to the interspinous fixation system. Visual analogue scale(VAS) was used to evaluate low back pain and lower limb pain,Japanese Orthopedic Association(JOA) score and Oswestry Disability Index(ODI) score were used to evaluate lumbar function. Surgical segment and adjacent segments,range of motion(ROM),disc height and the Pfirrmann grade of upper the adjacent segments were compared before and after operation. Results: Fifty-five patients were followed up from 48 to 72 months with an average of 60.4 months. VAS score of low back pain and lower limb pain,JOA and ODI score of lumbar at 48 months after operation were improved than before operation between two groups(P<0.01),but there was no statistical difference for group comparisons(P>0.05). ROM,disc height of surgical segments were significantly lower than those before operation between two groups (P<0.05),while ROM of the upper and lower adjacent segments and disc height did not change significantly (P>0.05). There was no significant difference in ROM and disc height for group comparisons(P>0.05). There was no change in Pfirrmann grade of the upper adjacent segment degeneration between two groups(P>0.05). Four patients with primary lumbar disc herniation had a recurrence of 1 to 3 years after operation,including 3 in Wallis group and 1 in Coflex group,with an average age of 35.2 years old. Conclusion: Wallis and Coflex interspinous implants have the similar mid-term efficacy for the treatment of lumbar degenerative diseases,and could delay adjacent segment degeneration,but could not prevent recurrence of disc herniation.