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采用椎间盘切除术和Wallis棘突间装置治疗多节段腰椎退行性疾病的至少5年随访

Minimum 5 year follow-up of multi-segmental lumbar degenerative disease treated with discectomy and the Wallis interspinous device.

作者信息

Jiang Yun-qi, Che Wu, Wang Hui-ren, Li Ruo-yu, Li Xi-lei, Dong Jian

机构信息

Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, People's Republic of China.

Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, People's Republic of China.

出版信息

J Clin Neurosci. 2015 Jul;22(7):1144-9. doi: 10.1016/j.jocn.2014.12.016. Epub 2015 Apr 15.

Abstract

We evaluate the clinical effects and radiological findings of the Wallis interspinous device (Zimmer, Warsaw, IN, USA) for the treatment of multi-segmental lumbar degenerative disease after a minimum 5 year follow-up period. A total of 26 adult patients underwent a primary discectomy followed by fixation of the segment with the Wallis interspinous device between December 2007 and August 2008. Twelve men and 14 women with an age range of 43 to 56 years (average: 47.6) were included. The visual analogue scale (VAS) for low back and leg pain, Oswestry Disability Index (ODI), foraminal height (FH), anterior disc height (aDH) and posterior disc height (pDH), range of motion (ROM) and Pfirrmann grades were obtained and compared before and after surgery. The VAS and ODI significantly decreased postoperatively (p < 0.05). The postoperative FH and pDH values increased significantly compared with the preoperative levels (p < 0.01) and the increase in the FH and pDH values remained statistically significant during the follow-up period. There were no statistically significant changes in the aDH values before and after surgery (p > 0.05). Also, there were no statistically significant changes in the ROM and Pfirrmann grade at the instrumented level and at the cephalad-adjacent segment (p>0.05). In our study, no patient underwent further surgery because of a re-prolapse or progression of index level degeneration or adjacent segment disease. The Wallis interspinous device was a useful alternative for treating multi-segmental lumbar degenerative disease and it offered a significant minimum 5 year symptom control.

摘要

我们评估了Wallis棘突间装置(美国印第安纳州华沙市Zimmer公司生产)在至少5年随访期后治疗多节段腰椎退行性疾病的临床效果和影像学表现。2007年12月至2008年8月期间,共有26例成年患者接受了初次椎间盘切除术,随后使用Wallis棘突间装置对病变节段进行固定。纳入研究的患者共12名男性和14名女性,年龄在43至56岁之间(平均年龄:47.6岁)。分别在手术前后获取并比较患者的下腰痛和腿痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)、椎间孔高度(FH)、椎间盘前缘高度(aDH)、椎间盘后缘高度(pDH)、活动度(ROM)以及Pfirrmann分级。术后VAS和ODI评分显著降低(p < 0.05)。术后FH和pDH值与术前水平相比显著增加(p < 0.01),并且在随访期间FH和pDH值的增加仍具有统计学意义。手术前后aDH值无统计学显著变化(p > 0.05)。此外,在植入装置节段及其相邻头侧节段,ROM和Pfirrmann分级也无统计学显著变化(p > 0.05)。在我们的研究中,没有患者因原节段退变复发、进展或相邻节段疾病而接受进一步手术。Wallis棘突间装置是治疗多节段腰椎退行性疾病的一种有效替代方法,并且至少能在5年内有效控制症状。

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