棘突间移植物治疗腰椎关节突关节退变的初期结果

目的 评价棘突间移植物-DIAM(device for intervertebral assisted motion)对腰椎关节突关节退变的治疗效果及相关术中、术后并发症.方法 对2005年8月至2006年4月接受DIAM移植的22例患者进行回顾性分析.女14例,男8例;平均年龄38.5(24～59)岁.单节段14例,双节段8例;单发腰椎关节突关节退变诱发腰痛16例(其中3例为腰椎人工间盘置换术后残留腰痛),腰椎间盘突出3例,腰椎管狭窄伴间歇性跛行2例,腰椎间盘后路摘除术后1例.结果手术时间为25 min(单节段)和35 min(双节段).术后所有患者随访16～28个月,平均17个月.术后影像学检查显示移植物无明显迁移.正位X线片显示移植物撑开了棘突间间隙,侧位X线片显示神经根管高度、椎间隙后高度术前及术后66周的比较差异有统计学意义(P<0.01).术后症状改善程度采用Odom评估法,优7例,良10例,可1例,差4例;优良率77.3%.视觉模拟评分由术前平均(7.09±0.92)分改善至术后66周平均(3.23±1.82)分,差异有统计学意义(P<0.01).随访期间未发生症状加重、移植物松脱及术后翻修.结论 应用棘突间移植物技术治疗单发的腰椎关节突关节退变,保留了腰椎后柱结构稳定性,操作简单.通过棘突间撑开作用降低了关节突关节的应力,增加了神经根管高度,恢复了腰椎后柱高度.

Preliminary results of the interspinous implants for treatment of lumbar degenerative diseases

Objective To describe our initial experience and evaluate the preliminary results as well as the possible complications of interspinous implant (device for intervertebral assisted motion, DIAMTM) in managing symptomatic lumbar degenerative disorders. Methods A group of 22 patients were analyzed ret-rospectively. Fourteen female and eight male patients were treated. Mean age was 38.5 (range, 24 -59) years. They had clinical evidence for lumbar facet joint pain and a facet joint injection therapy had good result. Pre-operatively MRI and CT scan was done to evaluate the lumbar spinous process, lumbar disc and facet joints. Fourteen patients were operated at single level, eight patients at double levels. Radiographic imaging, pain scores, and clinical assessments were obtained at 24th week, 66th week postoperatively. Results Pa-tients were evaluated clinically through the Odom's criteria: 31.8% (7 patients) excellent, 45.4% (10 patients) good, 4.5% (1 patient) fair and 18.1% (4 patients) poor results. A significant difference was observed in im-provement of visual analogue scale that decreased from preoperative mean 7.09±0.92 to postoperative mean 3.23±1.82. Statistically significant differences were noted in neural foraminal height and posterior disc height when comparing patients pre-and postoperatively. For the follow-up period, no migration and loosening of implant was found, and no revision surgery was needed in all cases. Conclusion In this preliminary result, it could be observed that the DIAMTM prosthesis can offer a pain relief in well selected patients suffering lum-bar facet joint pain. The indication should be very strict. The implant acts as: 1) A shock absorber, give dis-traction of the neuroforamina, realign facet interface; 2) Restore posterior column height and share in load transmission.