两种棘突间动态稳定系统置入后对腰椎结构的影响变化及对比分析  

Comparison of lumbar changes by using radiographic imaging after implanting two types of interspinous process devices

作　　者：王冰[1] 于秀淳[1] 周银[1] 张晶涛[1] 梁进[1] 袁冶[1] 

机构地区：[1]第二军医大学济南临床医院骨病科

出　　处：《中国矫形外科杂志》2014年第18期1642-1646,共5页Orthopedic Journal of China

摘　　要：[目的]对比分析两种棘突间动态稳定系统（X-Stop和Wallis）置入后对腰椎结构的影响变化。[方法]2009年11月-2011年8月收治的61例L4/5节段腰椎间盘退变性疾病患者,按入院时间和自身对手术的选择随机分为X-Stop组（A组,33例）和Wallis组（B组,28例）。两组患者性别、年龄、病变节段、病程等一般资料比较差异无统计学意义（P〉0.05）,具有可比性。分别于X线片上测量L4/5节段手术前后的Cobb角度变化、椎间孔横径及纵径/L5椎体后缘高度、椎间隙高度/L5椎体后缘高度。[结果]A组术后Cobb角、椎间隙后高度/L5椎体高度、椎间孔横径/L5椎体高度、椎间孔纵径/L5椎体高度均较术前有显著变化,成增大趋势（P值分别为：0.016、0.000、0.001和0.001）;B组术后Cobb角、椎间隙后高度/L5椎体高度、椎间孔横径/L5椎体高度、椎间孔纵径/L5椎体高度均较术前有显著变化,成增大趋势（P值分别为：0.000、0.000、0.001和0.000）。组间比较术前、术后变化,Cobb角（P=0.168〉0.05）、椎间孔横径/L5椎体高度（P=0.884〉0.05）、椎间孔横径/L5椎体高度（P=0.566〉0.05）的变化差异,A、B两组无统计学意义,椎间隙后高度/L5椎体高度存在组间差别（P=0.002〈0.05）,椎间隙后高度在两种不同动态稳定系统置入后变化的趋势不同,其中A组椎间隙后高度增加趋势更大。[结论]X-Stop系统与Wallis系统均可恢复腰椎生理曲度,有效增大椎间孔面积和椎间隙高度,是治疗腰椎间盘退变性疾病的一种安全、有效的外科方法,但X-Stop系统在增加椎间隙高度方面较Wallis系统有优势,且具有操作方便,不损伤相邻节段棘间韧带等优势。[Objective] To compare the postoperative lumbar changes by using radiographic imaging after implanting two types of interspinous process devices- X- Stop and Wallis for the treatment of lumbar degenerative disc disease.[Method]Between November 2009 and August 2011,61 patients with lumbar degenerative disc disease at the L4 /5segment were treated by performing surgical implantation of interspinous process devices： X- Stop in 33 patients（ group A） and Wallis in 28 patients（ group B）. The device was individually selected according to the patient＇s preference. There were no statistical differences between the two groups according to the sex,age,involved segment,and course of the disease（ P〉0. 05）. Radiographic measurements were performed before and after the lesion segment operation,considering the following variables： the Cobb angle,intervertebral foramen diameter,longitudinal diameter /lower vertebral height,and disc height /lower vertebral height. [Result]The measurement index significantly increased in the two groups（ P〈0. 05）. Between the two groups,the change in the Cobb angle,intervertebral foramen diameter,and longitudinal diameter /lower vertebral height did not show any significant difference（ P 〉0.05）,whereas the disc height /lower vertebral height changed（ P〈0. 05）. [Conclusion]Both X- Stop and Wallis can restore the physiological curvature of the spine,as well as effectively increase the intervertebral foramen area and the height of intervertebral space. Implantation of these devices is a safe and effective surgical method for the treatment of lumbar degenerative disc disease,however,the X- Stop is more effective compared to the Wallis in increasing the height of the intervertebral space,and has the advantages of being convenient and causing no damage to the section adjacent to the interspinal ligament.

关 键 词：腰椎间盘 退变性疾病 非融合技术 

分 类 号：R687.3[医药卫生—骨科学]