棘突间固定系统治疗腰椎退变性疾患的中期随访和失败病例分析  

Mid-term follow-up and analysis of the failure cases of interspinous implants for degenerative lumbar diseases

作　　者：孙浩林[1] 李淳德[1] 刘宪义[1] 林景荣[1] 邑晓东[1] 刘洪[1] 卢海霖[1] 

机构地区：[1]北京大学第一医院骨科,北京100034

出　　处：《北京大学学报（医学版）》2011年第5期690-695,共6页Journal of Peking University:Health Sciences

摘　　要：目的:通过随访腰椎棘突间固定系统治疗腰椎退变性疾患的病例和分析失败病例,探讨腰椎棘突间固定系统的适应证选择、疗效和应用注意事项。方法:2007年9月至2008年9月,北京大学第一医院骨科单独应用棘突间固定系统治疗腰椎退变性疾患病例52例,分为Wallis组25例、Coflex组27例,主要适应证包括椎间盘源性下腰痛、腰椎间盘突出症和轻度腰椎管狭窄症。采用腰痛视觉模拟评分(visual analog score,VAS)、下肢痛VAS评分和腰椎日本骨科协会(Japanese Orthopedic Association,JOA)评分(29分法)评定临床症状改善情况,采用Prolo腰椎功能评定标准评定术后功能改善情况,术前和末次随访各评价一次;术后随访过程中拍摄腰椎正、侧位X线片判定内固定物的位置、有无棘突骨折,测量术前和末次随访手术节段前凸角;末次随访拍摄腰椎过伸、过屈位X线片,测量过伸位和过屈位手术节段前凸角确定手术节段屈伸活动度(手术节段屈伸活动度=过伸位手术节段前凸角-过屈位手术节段前凸角);对椎间盘源性下腰痛病例,在随访过程中术后12个月拍摄腰椎MRI了解椎间盘变化情况。结果:52例病例获得完整随访,平均随访时间30.4个月;Wallis组末次随访腰痛VAS评分、下肢痛VAS评分、腰椎JOA评分和Prolo功能评分分别为(2.5±1.7)、(2.7±1.4)、(23.4±3.1)和(8.9±1.4),较术前(5.3±3.0)、(7.4±2.6)、(13.5±4.6)和(4.5±2.6)改善差异有统计学意义(腰痛VAS评分P=0.027,其余各项均为P<0.001);Coflex组末次随访腰痛VAS评分、下肢痛VAS评分、腰椎JOA评分和Prolo功能评分分别为(2.6±2.9)、(3.8±1.9)、(21.2±3.5)和(8.5±1.8),较术前(5.5±3.2)、(7.1±2.8)、(13.1±4.8)和(4.2±2.5)改善差异有统计学意义(腰痛VAS评分P=0.036,其余各项均为P<0.001);两组间比较术后下肢痛VAS评分,Wallis组为(2.7±1.4),Coflex组为(3.8±1.9),P=0.039,术后腰痛VAS评分、腰椎JOA评分和Prolo功能评分两�Objective：To assess the indications,efficacy and safety of application of interspinous implants for degenerative lumbar diseases by mid-term follow-up and analysis of the failure cases.Methods： In our study,52 cases of degenerative lumbar diseases treated with interspinous implants From September 2007 to September 2008 were divided into Wallis group（25 cases） and Coflex group（27 cases）.The clinical results were assessed by lumbar pain visual analog score（VAS） and lower limber pain VAS,lumbar Japanese Orthopedic Association（JOA） score and Prolo functional score;the radiological results including implant positon,segmental lodosis and segment movement degree were assessed by lumbar X ray post-operation compared with pre-operation.For cases of discogenic low back pain,lumbar disc changes were assessed by lumbar MRI 12 months post operation.Results： Fifty-two cases had complete follow-up and the average time was 30.4 months.In the final follow up,lumbar pain VAS,lower limber pain VAS,lumbar JOA score and Prolo functional score of Wallis group were（2.5±1.7）,（2.7±1.4）,（23.4±3.1）and（8.9±1.4）,which were better than pre-operation（5.3±3.0）,（7.4±2.6）,（13.5±4.6）and（4.5±2.6）,lumbar pain VAS P=0.027,all others P0.001;lumbar pain VAS,lower limber pain VAS,lumbar JOA score and Prolo functional score of Coflex group were（2.6±2.9）,（3.8±1.9）,（21.2±3.5）and（8.5±1.8）,which were better than pre-operation（5.5±3.2）,（7.1±2.8）,（13.1±4.8）and（4.2±2.5）,lumbar pain VAS P=0.036,all others P0.001;in the final follow up,lower limber pain VAS of Wallis group was（2.7±1.4）,which was better than（3.8±1.9） of Coflex group（P=0.039）;in the final follow up,Segment lodosis angles of Wallis group was 14.3°±3.9°,which was larger than 13.2°±3.5°of Coflex group（P=0.028）;Segment movement degree of Wallis group was 9.6°±2.8°,which was smaller than 12.8°±3.0°of Coflex group（P=0.019）.In Coflex group,four cases of lumbar disc hernia

关 键 词：腰椎 内固定器 椎间盘移位 椎管狭窄 

分 类 号：R681.53[医药卫生—骨科学]