Waveflex弹性系统结合髓核摘除修复腰椎间盘突出症:近期相邻节段无退变  

Discectomy plus Waveflex dynamic system for lumbar disc protrusion: no regeneration of adjacent segments

作　　者：孙郁雨[1] 崔志明[1] 张金龙[1] 李卫东[1] 保国锋[1] 徐冠华[1] 王玲玲[1] 陈佳佳[1] 陈黎敏[2] 

机构地区：[1]南通大学第二附属医院脊柱外科,江苏省南通市226001 [2]南通大学第二附属医院手术室,江苏省南通市226001

出　　处：《中国组织工程研究》2014年第53期8584-8589,共6页Chinese Journal of Tissue Engineering Research

基　　金：南通市科学技术局资助项目(BL2014061)~~

摘　　要：背景:脊柱的刚性固定融合是修复腰椎退变和不稳的传统方法,但是还存在相应的并发症,临床满意率不高。Waveflex是一种非融合椎弓根螺钉半刚性固定系统,它能适当的维持节段间正常运动,保留及恢复受损髓核的功能,而且对临近节段无不利影响。目的:对后路Waveflex非融合椎弓根螺钉弹性固定结合小开窗髓核摘除修复腰椎间盘突出症进行短期疗效评价。方法:纳入腰椎间盘突出症患者64例,其中弹性固定组34例行腰椎后路小开窗髓核摘除结合Waveflex弹性固定,髓核摘除组30例行单纯髓核摘除。随访分析患者疗效和并发症,定期进行腰痛目测类比评分、下腰痛日本骨科协会评分、Oswestry功能障碍指数评估,并复查腰椎正侧位X射线片及MRI,测量相关指标。结果与结论:患者术后随访12-22个月。两组末次随访腰痛目测类比评分、下腰痛日本骨科协会评分、Oswestry功能障碍指数均较治疗前明显改善(P<0.05),动态固定组末次随访腰痛的缓解率优于较髓核摘除组(P<0.05)。末次随访弹性固定组手术节段的活动范围小于治疗前,而椎间盘高度及MRI T1值大于治疗前(P<0.05)。髓核摘除组末次随访和治疗前相比未发生明显变化。末次随访两组间比较,弹性固定组在控制手术节段过度随意移动、椎间高度及髓核修复上要优于髓核摘除组,而对邻近节段的影响与髓核摘除组无明显差异。提示与单纯髓核摘除相比,Waveflex系统结合小开窗髓核摘除修复腰椎间盘突出症具有满意的近期疗效,且对手术节段稳定性及髓核修复有积极作用,近期不会导致邻近节段退变。BACKGROUND： Spine rigid fixation and fusion are the traditional surgical methods for treatment of lumbar degeneration and instability. However, there are corresponding complications and clinical satisfaction rate is not high enough. Waveflex is a dynamic semi-rigid non-fusion pedicle screw fixation system for the treatment of lumbar degeneration and instability. It can maintain appropriately the dynamic movement at the operative segments, retain and restore the function of the damaged nucleus, and have no adverse impact on adjacent segments. OBJECTIVE： To evaluate the short-term results of small-window discectomy combined with Waveflex non-fusion pedicle screw fixation system in treatment of lumbar disc protrusion. METHODS： Sixty-four patients with lumbar disc protrusion were involved in this study, among them 34 cases follow-ups. Low back pains were evaluated by VAS score, JOA score and ODI. The anterioposterior and lateral X-ray and MRI of the lumbar vertebrae were recorded. RESULTS AND CONCLUSION： The involved patients were followed up for 12-22 months. At final follow-up in two groups, the lower back pain VAS scores, JOA scores and ODI were significantly improved compared with before surgery （P 〈 0.05）. The remission rate of lower back pain in the dynamic fixation group was better than that in the discectomy group （P 〈 0.05）. The range of motion in the dynamic fixation group was less than that before surgery, while intervertebral height and MRI T1 values were more than before surgery （P 〈 0.05）. There was no significant difference in the discectomy group at final follow-up and before surgery. At the final follow-up, the dynamic fixation group was better than the discectomy group in terms of controlling the range of motion, intervertebral height and nucleus pulposus restoration, but the impact on the adjacent segments was similar between the two groups. Compared with posterior discectomy surgery, small-window discectomy combined with Wavefiex non-fusion pedicle screw fixation system c

关 键 词：腰椎 椎间盘移位 内固定器 随访研究 植入物 脊柱植入物 腰椎间盘突出症 Waveflex弹性固定系统 髓核摘除 近期疗效 

分 类 号：R318[医药卫生—生物医学工程]