动态稳定系统治疗腰椎退变性疾病的节段运动分析  

Analyses of segment motor function in patients with degenerative lumbar disease on the treatment of WavefleX dynamic stabilization system

作　　者：伍峻松[1] 杜峻华[1] 姜香云[1] 王权[1] 李喜功[1] 杜靖宇[1] 林向进[1] 

机构地区：[1]浙江大学医学院附属第一医院骨科,杭州310003

出　　处：《中华医学杂志》2014年第23期1769-1772,共4页National Medical Journal of China

摘　　要：目的：探讨动态稳定系统对腰椎运动功能影响的变化规律和趋势。方法对2011年10月至2012年11月浙江大学医学院附属第一医院骨科接受WavefleX动态稳定系统固定的9例腰椎退变性疾病患者进行了12个月5个时间点的腰椎运动范围（ ROM）随访测定，观察动态稳定系统固定节段、邻近节段和全腰段的ROM变化。同期随机选取的单一节段L5/SI融合和单一节段L4/5融合各5例（共计10例）进行对比分析。结果与术前ROM相比，腰椎非融合WavefleX动态固定的不同节段术后及多时点随访测定值明显减低（P＜0.05，P＜0.01）；而邻近节段的ROM有不同程度的增加（仅L3/4节段在12个月时点测定差异有统计学意义，P＜0.05），与接受单纯融合术的同时点对照组相比，术后6个月和12个月的ROM测定值在L3/4、L4/5和L5/S1降低（P＜0.05，P＜0.01）；全腰段的ROM连续时间点测定显示，单纯使用WavefleX非融合动态固定或是混杂有融合固定技术，与术前比较，全腰段ROM有明显减低（P＜0.01），但随着随访时间的延续，ROM有连续增加的趋势，与接受单纯融合术的同时点对照组相比，术后4个时间点的测量显示全腰段活动度增加（ P＜0.01）。结论 WavefleX动态稳定系统可以限制腰椎目标节段过度曲伸同时保留一定的运动功能，使邻近运动节段保持一定的腰椎生理前凸并减轻分散椎间盘载荷，起到力学的传承作用，进而减缓邻近节段退变的过早发生；全腰段的运动范围有连续增加的趋势。Objective To explore the changes of range-of-motion （ ROM ） in patients with degenerative lumbar disease on the treatment of WavefleX dynamic stabilization system and examine the postoperative lumbar regularity and tendency of ROM.Methods Nine patients with degenerative lumbar disease on the treatment of WavefleX dynamic stabilization system were followed up with respect to ROMs at 5 timepoints within 12 months.Records of ROM were made for instrumented segments , adjacent segments and total lumbar.Results Compared with preoperation , ROMs in non-fusional segments with WavefleX dynamic stabilization system decreased statistical significantly （ P 〈0.05 or P 〈0.01 ） at different timepoints;ROMs in adjacent segments increased at some levels without wide statistical significance.The exception was single L3/4 at Month 12（P〈0.05）versus control group simultaneously at the levels of L 3/4, L4/5 and L5/S1, ROMs decreased at Months 6 and 12 with wide statistical significance （ P〈0.05 or P〈0.01）.ROMs in total lumbar had statistical significant decrease （ P〈0.01） in both group of non-fusional segments and hybrid group of non-fusion and fusion.The trends of continuous augments were observed during follow-ups.Statistically significant augments were also acquired at 4 timepoints as compared to control group （ P 〈0.01 ） .Conclusion The treatment of degenerative lumbar diseases with WavefleX dynamic stabilization system may limit excessive extension/inflexion and preserve some motor functions.Moreover, it can sustain physiological lordosis , decrease and transfer disc load in adjacent segments to prevent early degeneration of adjacent segment.Trends of motor function augment in total lumbar need to be confirmed during future long-term follow-ups.

关 键 词：腰椎 脊柱融合术 椎间盘 WavefleX系统 

分 类 号：R687.3[医药卫生—骨科学]