中国组织工程研究

中国组织工程研究 ›› 2015, Vol. 19 ›› Issue (44): 7131-7136.doi: 10.3969/j.issn.2095-4344.2015.44.015

• 脊柱植入物 spinal implant • 上一篇    下一篇

Waveflex弹性固定与髓核摘除纤维环修复重建腰椎间盘突出患者脊柱稳定性

张兆川，姜效韦，戴维享，吴德慧，马 超，王兆红，韩 猛，冯 杰，刘光普   

  1. 徐州市中心医院骨科，江苏省徐州市  221009
  • 收稿日期:2015-09-21 出版日期:2015-10-22 发布日期:2015-10-22
  • 通讯作者: 姜效韦，博士，主治医师，徐州市中心医院，东南大学附属徐州医院骨科，江苏省徐州市221009
  • 作者简介:张兆川，男，1979年生，河南省焦作市人，汉族，苏州大学在读博士，主治医师，主要从事脊柱创伤及退行性方面相关疾病的研究。
  • 基金资助:

    徐州市中心医院博士创新团队科技项目(XZB201311)

Waveflex elastic fixation and discectomy annulus in repair and reconstruction of spinal stability in patients with lumbar disc herniation

Zhang Zhao-chuan, Jiang Xiao-wei, Dai Wei-xiang, Wu De-hui, Ma Chao, Wang Zhao-hong, Han Meng, Feng Jie, Liu Guang-pu   

  1. Department of Orthopedics, Xuzhou Central Hospital, Xuzhou 221009, Jiangsu Province, China
  • Received:2015-09-21 Online:2015-10-22 Published:2015-10-22
  • Contact: Jiang Xiao-wei, M.D., Attending physician, Department of Orthopedics, Xuzhou Central Hospital, Xuzhou 221009, Jiangsu Province, China
  • About author:Zhang Zhao-chuan, Studying for doctorate, Attending physician, Department of Orthopedics, Xuzhou Central Hospital, Xuzhou 221009, Jiangsu Province, China
  • Supported by:

    a Science and Technology Project Funded by Xuzhou Central Hospital Medical Doctor’s Innovation Team, No.XZB201311.

PDF

577

被引次数

8

摘要：

背景：青壮年腰椎间盘突出症患者因其病理的特殊性，对治疗要求更高，传统的髓核摘除及刚性固定融合存在相应的并发症，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，结合纤维环修复技术，可维持节段间正常运动，提高临床满意率。
目的：对后路Waveflex非融合椎弓根螺钉弹性固定小开窗髓核摘除结合纤维环修复治疗青壮年腰椎间盘突出症进行短期疗效评价。
方法：纳入青壮年腰椎间盘突出症患者38例，其中弹性固定组18例行腰椎后路小开窗髓核摘除纤维环修复结合Waveflex弹性固定，髓核摘除组20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(JOA)、Oswestry功能障碍指数(ODI)评估，并复查腰椎正侧位X射线片测量相关指标。
结果与结论：患者治疗后随访12-20个月。两组末次随访时腰痛目测类比评分、下腰痛JOA评分、腰痛ODI均优于治疗前(P < 0.05)；动态固定组末次随访腰痛目测类比评分、下腰痛JOA评分、腰痛ODI评分优于髓核摘除组(P < 0.05)。末次随访中，弹性固定组手术节段的椎间隙高度大于治疗前，而手术节段活动范围较治疗前减小(P < 0.05)。提示与传统髓核摘除相比，Waveflex系统结合髓核摘除纤维环修复治疗青壮年腰椎间盘突出症的早期腰椎功能恢复更为满意，且对手术节段稳定性有积极作用。
中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 骨科植入物, 脊柱植入物, 腰椎间盘突出症, Waveflex弹性固定系统, 髓核摘除, 纤维环修复, 近期疗效

Abstract:

BACKGROUND: For reason of pathological particularity, treatments for young adult patients with lumbar disc herniation require more demanding procedures. Traditional discectomy and rigid fixation and fusion receive a lower clinical satisfaction rate because of their concomitant complications. Waveflex is a semi-rigid fixation system with non-fusion pedicle screws. Once combined with the technology of annulus repair, it can maintain the normal movement of the segments, and can thus raise clinical satisfaction rate.

OBJECTIVE: To evaluate the short-term efficacy of the treatment of young adult lumbar disc herniation through the technology of the posterior Waveflex non-fusion pedicle screw elastic fixed small window nucleus pulposus extirpation associated with annulus repair.
METHODS: Thirty-eight patients with lumbar disc herniation were involved in this study, among which, 18 cases in the elastic fixation group were subjected to a posterior lumbar small window nucleuspulposus extraction along with annulus repair together bound with Waveflex elastic fixation; the rest 20 cases in the nucleus pulposus removal group underwent simple nucleus pulposus extirpation. After these operations, a series of follow-up study was conducted, including: follow-up analysis of clinical efficacy and complications, collection of low-back pain visual analogue scores, collection of Japanese Orthopaedic Association scores (JOA), regular assessment of Oswestry dysfunction index, and reevaluation of the lumbar lateral radiographs related indicators.

RESULTS AND CONCLUSION: Follow-up visits to the patients were conducted 12-20 months later since the operations. Both groups showed a better performance than before treatment in the pain visual analogue scale, low back pain JOA score, and Oswestry dysfunction index of low-back pain (P < 0.05) during the last visit. The pain visual analogue scale, low back pain JOA score, and Oswestry dysfunction index of low-back pain in the dynamic fixation group were superior to those in the nucleus pulposus removal group (P <0.05). Still in the last follow-up, operative segment disc height in the dynamic fixation group was greater than that before treatment, and the operative segment range of motion was smaller than that before treatment (P <0.05). These results suggest that compared to nucleus pulposus removal, Waveflex system associated with nucleus pulposus excision annulus repair has a more satisfactory effect in the early recovery of lumbar spine function and exerts a positive effect on the stability of the operated segments in the treatment of lumbar protrusion of the intervertebral disc in young adults.
中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Lumbar Vertebrae, Intervertebral Disk Displacement, Internal Fixators, Follow-up, Tissue Engineering