经皮植入棘突间撑开系统治疗腰椎管狭窄症伴腰椎不稳的短期疗效分析  

The analysis on short-term clinical efficacy of In-Space after decompressive laminectomy for treatment of degenerative lumbar spinal stenosis with vertebral instability

作　　者：杜瑞[1] 周栋[1] 农鲁明[1] 徐南伟[1] 谢华[1] 蒋世杰[1] 高共鸣[1] 

机构地区：[1]南京医科大学附属常州第二人民医院骨科,213000

出　　处：《中国医师进修杂志》2011年第35期4-7,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨椎板开窗减压加In-Space经皮植入棘突间撑开系统与单纯椎板开窗减压治疗腰椎管狭窄症伴腰椎不稳短期疗效的不同。方法选取2009年5月至2010年7月收治的33例腰椎管狭窄症伴腰椎不稳患者，采用随机数字表法分为A组和B组。A组16例，采用椎板开窗减压加In—Space经皮植入棘突间撑开系统；B组17例，采用单纯椎板开窗减压。术前，术后1d，术后1、3、6个月及末次随访分别摄腰椎正、侧位及动力位X线片，测量植入节段椎间隙前、后缘高度，椎弓根间距离，腰椎活动度。并采用Oswestry功能障碍指数（ODI）和视觉模拟评分法（VAS）对临床疗效进行评价。结果全部病例随访6．21（13．20±2．91）个月。A组术后各时间点椎间隙前缘高度较术前略有下降（P〉0．05），术后1d椎间隙后缘高度、术后各时间点椎弓根间距离均较术前明显增高，差异有统计学意义（P〈O．05）。而B组术后1d，术后1、3个月椎间隙前缘高度、椎间隙后缘高度、椎弓根间距离与术前比较差异无统计学意义（P〉0．05），术后6个月、末次随访较术前或术后1d明显降低，差异有统计学意义（P〈0．05）。A组腰椎活动度由术前的9．86°±1．90°减小到末次随访的5．60°±2．02°，B组腰椎活动度由术前的9．89°±2．00°增大到末次随访的10．76°±3．14°（P〈0．05）。在末次随访中，A组腰背部疼痛VAS、ODI评分[（2．02±1．98）、（20．18±18．80）分]均明显低于B组[（4．15±2．36）、（30．39±16．62）分]，差异有统计学意义（P〈0．05）。所有患者未发生假体松动、断裂及脱落。结论In-Space经皮植入棘突间撑开系统能够较好地维持脊柱活动度及稳定性，防止椎间隙塌陷及继发腰椎不稳的发生，短期疗效满意。Objective To investigate the difference of short-term clinical efficacy between decompressive laminectomy into In-Space and simple decompressive laminectomy for treatment of lumbar spinal stenosis with vertebral instability. Methods Thirty-three patients with lumbar spinal stenosis with vertebral instability admitted from May 2009 to July 2010,were divided into two groups by random number table. Group A of 16 cases was treated with laminectomy decompression and placement In-Space, group B of 17 cases was treated with laminectomy decompression. Lumbar anteroposterior,lateral and flexion-extension X-ray films, preoperatively,and the follow-up were used to measure anterior and posterior disc height, foraminal height, segmental lordotic angle at surgical level. Using Oswestry disability index （ODI） and the visual analogue scale （VAS） to evaluate the clinical efficacy. Results All patients were followed up for （13.20 ± 2.91 ） months （range 6 to 21 months）. The anterior disc height after operation of group A was slightly decreased compared with the preoperative（P 〉 0.05 ）, the posterior disc height at 1 day after operation and foraminal height after operation of group A were significantly increased compared with the preoperative （P 〈 0.05）. The anterior and posterior disc height,foraminal height of group B at 1 day, 1 month,3 months after operation were no significantly different compared with the preoperative （P 〉 0.05）, at 6 months after operation and the end of follow-up were significantly decreased compared with the preoperative or 1 day after operation （P 〈 0.05 ）. Activity of lumbar vertebra by preoperative 9.86° ± 1.90° decreased to the end of follow- up 5.60° ± 2.02° in group A, while activity of lumbar vertebra by preoperative 9.89° ± 2.00° increased to the end of follow-up 10.76°± 3.14° in group B. At the end of follow-up, lumbar back pain VAS, ODI score [ （2.02 ± 1.98 ）, （20.18 ± 18.80） scores ] of group A were significantly lower than those of g

关 键 词：椎管狭窄 减压术 外科 动态稳定系统 

分 类 号：R681.5[医药卫生—骨科学]