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  

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

作　　者：赵宇[1] 邱贵兴[1] 王以朋[1] 赵宏[1] 仉建国[1] 王乃国[1] 周熹[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院骨科,100730

出　　处：《中华骨科杂志》2010年第5期473-476,共4页Chinese Journal of Orthopaedics

摘　　要：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，ODI）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（k，）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。Objective To investigate clinical efficacy of dynamic interspinous assisted motion （DIAM） system in treatment of degenerative lumbar disease. Methods Eight cases with lumbar vertebral instability were treated with the DIAM system at Peking Union Medical College Hospital from June 2006 to January 2008. There were 6 female and 2 male cases, with a mean age of 46.9 years ranging from 40 to 57 years. 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 of 20.6 months. The ODI scores before surgery and at 3-month, 6-month, 1-year intervals and final follow-up after 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 scores 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 difference 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 L45 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 between preoperative L45 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 correlated with segment activity （r〉0.7, P〈0.05）. Conclusion The DIAM system appears to be a useful and effective 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.

关 键 词：腰椎 腰痛 假体和植人物 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]