中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (4): 609-614.doi: 10.3969/j.issn.1673-8225.2010.04.009

• 人工假体 artificial prosthesis • 上一篇    下一篇

Wallis动态稳定系统置入治疗腰椎失稳症的效果

梁春祥，陈克冰，刘少喻，韩国伟，龙厚清，魏富鑫，黄阳亮   

  1. 中山大学附属第一医院脊柱外科，广东省广州市  510700
  • 出版日期:2010-01-22 发布日期:2010-01-22
  • 通讯作者: 刘少喻，中山大学附属第一医院脊柱外科，广东省广州市 510700 gzsyliu@tom.com
  • 作者简介:梁春祥，男，1963年生，吉林省吉林市人，汉族，1988年北华大学毕业，副主任医师，主要从事脊柱外科的研究。 lchxzhrl@yahoo.com.cn

Application of Wallis dynamic stabilization system in surgical treatment of lumbar segmental instability: Effect evaluation

Liang Chun-xiang, Chen Ke-bing, Liu Shao-yu, Han Guo-wei, Long Hou-qing, Wei Fu-xin, Huang Yang-liang   

  1. Department of Spinal Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou  510700, Guangdong Province, China
  • Online:2010-01-22 Published:2010-01-22
  • Contact: Liu Shao-yu, Department of Spinal Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510700, Guangdong Province, China
  • About author:Liang Chun-xiang, Associate chief physician, Department of Spinal Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510700, Guangdong Province, China gzsyliu@tom.com

PDF

881

被引次数

12

摘要：

背景：为保证可控制范围内的脊柱运动，改变失稳节段运动的负荷模式，并限制其异常活动，同时避免相邻节段椎间盘退变的发生，多种后路腰椎非融合固定装置被研发并用于临床。
目的：探讨Wallis动态稳定系统治疗腰椎失稳症的临床效果。
方法：选择中山大学附属第一医院脊柱外科收治的腰椎失稳症患者10例，男3例，女7例，年龄43~65岁，其中失稳节段1例为L 1/2和L4/5，1例为L 2/3，1例为L 3/4，其余均为L 4/5；合并相同节段腰椎间盘突出症2例，腰椎管狭窄症7例，相邻节段腰椎管狭窄症3例；失稳节段均行后路椎管减压、Wallis置入固定治疗。观察治疗前后视觉模拟VAS评分、下腰痛JOA评分、Oswestry功能障碍指数变化；失稳节段和相邻节段的活动范围及L 4/5节段椎间盘后高度的变化。
结果与结论：10例患者均获得随访，随访时间2~13个月，平均9.2个月。手术时间平均128 min(90~185 min)，术中平均出血量264 mL (50~600 mL)。腰痛均消失，术后患者的症状和体征均有明显改善；1例置入治疗后3个月因L4/5右侧腰椎管狭窄症复发，再行开窗减压术后症状消失。治疗后VAS评分较术前显著降低(P=0.003)；JOA评分较术前显著增加(P=0.002)，ODI评分较术前显著降低(P=0.008)。术后L 4/5节段的活动范围与术前相比明显减少(P < 0.05)，而术后相邻节段L 3/4、L5/S1的活动范围与术前相比差异无显著性意义(P > 0.05)。提示Wallis动态稳定系统置入治疗腰椎失稳症能够取得比较满意的临床效果。

关键词: 腰椎, 动态稳定, 失稳, 非融合, 棘突

Abstract:

BACKGROUND: Posterior lumbar non-fusion devices have been developed to control vertebral column movement, change load pattern of instability segment, restrict abnormal action, as well as avoid adjacent segment degeneration.
OBJECTIVE: To investigate the efficiency of Wallis dynamic stabilization system in the treatment of lumbar vertebrae instability. 
METHODS: Ten cases suffering from lumbar instability were selected, including 3 males and 7 females, aged 43-65 years. One patient sustained L 1/2 and L 4/5 segmental instability, one was L 2/3 and another was L 3/4, and the others were L 4/5. Two patients complicated with lumbar disc herniation and 7 patients combined with lumbar spinal stenosis at the same affected segment, and 3 patients associated with lumbar spinal stenosis at adjacent segment. All unstable segments were treated with decompression, posterior implantation of Wallis dynamic stabilization system. Visual analogue scale (VAS) and Japanese Orthopedic Association (JOA) scores for low back pain and Oswestry disability index (ODI) were used to evaluate clinical outcomes. In addition, the range of motion (ROM) at the instrumented segment and adjacent segments and posterior disc height (PDH) in standing and extension position at L 4/5 segment were also measured.
RESULTS AND CONCLUSION: All the patients were followed-up for 2-13 months, mean 9.2 months. The mean operation duration was 128 minutes (90-185 minutes), with bleeding volume of 264 mL (50-600 mL). Sings and symptoms of all patients were improved significantly after operation, except one patient with recurrence of L 4/5 lumbar spinal stenosis at 3 month after surgery, whose symptoms relieved by revision with fenestration and decompression. The postoperative VAS was dramatically decreased than that of preoperation (P=0.003); the JOA score was obviously increased (P=0.002), and the ODI score was decreased (P=0.008). The postoperative range of motion decreased significantly (P < 0.05). However, there was no obviously difference between preoperative and postoperative L 3/4, L5/S1 and posterior disc height (P > 0.05). Good clinical results can be achieved by surgical intervention with Wallis dynamic stabilization system in treating lumbar vertebrae instability.

中图分类号: