棘突间动态内固定系统在腰椎间盘退变性疾病中的应用及中期随访结果  

Application and midterm follow-up of interspinous process spacer( X-Stop ) in the treatment of degenerative disc diseases

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

机构地区：[1]第二军医大学济南临床学院骨病科,山东250031

出　　处：《中国骨与关节杂志》2015年第3期224-229,共6页Chinese Journal of Bone and Joint

摘　　要：目的探讨棘突间动态内固定系统（X-Stop）治疗腰椎间盘退变性疾病（degenerative disc disease,DDD）的中期临床疗效及手术适应证。方法回顾性分析2009年11月至2011年12月,我科应用X-Stop治疗且随访时间〉2年的单间隙DDD患者共47例,其中男16例,女31例,平均年龄（56.3±11.1）岁,主要诊断包括腰椎管狭窄症、腰椎间盘突出症、腰椎不稳症等,采用腰痛视觉模拟评分（visual analog score,VAS）和腰椎日本骨科协会（Japanese orthopedic association,JOA）评分（29分法）评定临床症状改善情况,术前和末次随访各评价一次。结果手术时间平均70 min,术中平均出血量平均67.2（20-300）ml,术后随访时间平均37.2（25-50）个月,其中3例术后残余轻度腰痛及下肢麻木症状,经保守治疗后症状缓解;3例术后出现假体向棘突后方脱出,1例予以假体取出,其余2例因无明显不适症状,未行特殊治疗。随访过程中未发现棘突骨折、腰椎后凸畸形、邻近节段退变等其它相关并发症。下腰痛JOA评分与术前相比较差异有统计学意义（术前13.30±2.79,末次随访27.55±1.38,P〈0.05）,腰痛VAS评分与术前相比较差异有统计学意义（术前5.74±0.97,末次随访1.06±0.92,P〈0.05）。结论 X-Stop临床疗效确切,手术操作损伤小、术后康复快、相关并发症发生率低,是治疗DDD的一种安全、有效的外科方法,但手术适应证选择应慎重,其远期疗效仍有待进一步观察。Objective To explore the midterm clinical results and surgical indications of interspinous process spacer（ X-Stop） in the treatment of degenerative disc diseases（ DDD）. Methods From November 2009 to December 2011, a total of 47 patients with single-level DDD underwent interspinous process spacer（ X-Stop） surgery, who were all followed up for more than 2 years. Their clinical data were retrospectively analyzed. There were 16 males and 31 females, whose mean age was（ 56.3±11.1） years. They were diagnosed as lumbar spinal stenosis, prolapse of lumbar intervertebral disc, lumbar spinal instability and so on. The Visual Analogue Scale（ VAS） and Japanese Orthopedic Association（ JOA） score（ 29 points） were used to evaluate the improvement of clinical symptoms, and the scores were recorded preoperatively and in the latest follow-up. Results The mean operation time was 70 min, and the mean blood loss was 67.2 ml（ range： 20-300 ml）. The postoperative follow-up time was 37.2 months on average（ range： 25-50 months）. Three patients had residual low back pain and lower limb numbness, which were relieved after the conservative treatment. The X-Stop device dropped out behind the spinous process in 3 patients. Among them, a patient had the X-Stop device removed, the other 2 patients with no obvious symptoms received no special treatment. During the follow-up, no other complications were found, such as spinous process fractures, lumbar kyphosis and adjacent segment degeneration. The low back pain JOA scores were increased from（ 13.30±2.79） points preoperatively to（ 27.55±1.38） points in the latest follow-up, and the differences were statistically signifi cant（ P〈0.05）. The back pain VAS scores were decreased from（ 5.74±0.97） points preoperatively to（ 1.06±0.92） points in the latest follow-up, and the differences were statistically signifi cant（ P〈0.05）. Conclusions The interspinous process spacer（ X-Stop） is a more popular choice for DDD, because of its a

关 键 词：腰椎 椎间盘退行性变 内固定器 外科手术 

分 类 号：R681.5[医药卫生—骨科学] R687.3[医药卫生—外科学]