In—Space经皮棘突间撑开系统治疗腰椎不稳症的初步效果分析  

Preliminary effect of In-Space percataneous interspinous spacer in the treatment of lumbar instability

作　　者：农鲁明[1] 周栋[1] 高共鸣[1] 蒋羽清[1] 徐南伟[1] 

机构地区：[1]南京医科大学附属常州第二人民医院脊柱外科,常州213000

出　　处：《中华骨科杂志》2013年第1期26-31,共6页Chinese Journal of Orthopaedics

摘　　要：目的探讨In—Space经皮棘突间撑开系统治疗腰椎不稳症的初期临床效果。方法回顾性分析2009年5月至2011年6月采用In—Space经皮棘突间撑开系统治疗腰椎不稳18例患者资料，男10例，女8例；年龄39--58岁，平均48．6岁；L3.4 5例，L4．5，13例。患者均伴有不同程度的腰椎过伸性腰背疼痛症状，并伴有一侧下肢的节段性放射性疼痛，屈曲位时缓解。采用视觉模拟评分（visual ana logue scale，VAS）对手术前后疼痛进行评估；采用Oswestry功能障碍指数（Oswestry disability index，ODI）对手术前后腰椎功能进行评价。测量术前及术后手术节段棘突间距离、椎间隙前后缘高度、椎间孔高度和宽度、前凸角以及活动度，并进行比较。结果18例患者均获得随访，随访时间18-36个月，平均（25±2．9）个月。术后6周及末次随访VAS评分为（3．1±1．3）分和（1．5±0．8）分，与术前（7．9±2．1）分比较，差异有统计学意义；术后6周及末次随访ODI为54．7％±14．8％和10．1％±2．5％，与术前82．1％±13．1％比较差异有统计学意义。术后棘突间距离为（9．29±1．43）mm，椎间隙后缘高度为（11．28±0．85）mm，椎间孔高度和宽度分别为（21．27±1．01）mm和（10．83±0．73）mm；节段前凸角及节段活动度分别为7．62°±0．74°和6．34°±0．81°。患者切口均一期愈合，无一例发生棘突骨折、脊髓损伤、脑脊液漏及装置移位、脱出等并发症。结论In—Space棘突间撑开系统治疗腰椎不稳退行性疾病简便安全，初期随访疗效良好。Objective To evaluate preliminary effect of In-Space percataneous interspinous spacer in the treatment of lumbar instability. Methods Data of 18 patients who had undergone interspinous spacer implant for lumbar instability from May 2009 to June 2011 were retrospectively analyzed. There were 10 males and 8 female, aged from 39 to 58 years. All patients suffered from varying degrees of lower back pain induced by lumbar hyperextension, as well as radiating and segmental pain of unilateral lower limb. The vi- sual analogue scale （VAS） and Oswestry disability index （ODI） were used to evaluate clinical outcomes. The pre- and postoperative interspinous distance, trailing edge height of intervertebral space, foraminal width, foraminal height, segmental lordotic angle and lumbar range of motion were tested and compared. Results All patients were followed up for 18 to 36 months. The VAS score improved from preoperative 7.9±2.1 to 3.1±1.3 at 6 months postoperatively and 1.5±0.8 at final follow-up. The ODI improved from preoperative 82.1%±13.1% to 54.7%±14.8% at 6 months postoperatively and 10.1%±2.5% at final follow-up. The postop- erative interspinous distance, trailing edge height of intervertebral space, foraminal height, foraminal width, segmental lordotic angle and lumbar range of motion were 9.29±1.43 mm, 11.28±0.85 ram, 21.27±1.01 mm, 10.83±0.73 mm, 7.62°±0.74° and 6.34°±0.81°, respectively. Wound healed smoothly in all patients, and there were no complications such as spinous process fracture, spinal cord injury, cerebrospinal fluid leakage, device displacement and device dislocation. Conclusion It is easy and safe to use In-Space percataneous interspinous spacer in the treatment of lumbar instability, and the preliminary effect is satisfactory.

关 键 词：腰椎 内固定器 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]