Wallis棘突间动态内固定治疗老年节段性腰椎管狭窄的短期临床效果

Short-term clinical outcomes of Wallis interspinous dynamic stabilization for single-segmental lumbar spinal stenosis in the aged

摘要:

目的 探讨后路椎管减压和Wallis棘突间动态内固定治疗老年节段性腰椎管狭窄症的术后短期临床效果。方法 回顾性分析2008年1月至2010年12月在解放军空军总医院行后路椎管减压、Wallis棘突间动态内固定治疗的25例腰4-5节段椎管狭窄症的老年患者。男11例，女14例；平均年龄65岁。所有患者随访期均≥6个月。记录所有患者术前、术后3天、术后1个月、术后6个月Oswestry功能障碍指数（ODI）评分及视觉模拟评分(VAS)评分，测量手术节段（腰4-5）和邻近节段（腰3-4、腰5-骶1）椎间隙与椎间孔高度。记录所有患者术中、术后并发症。结果 25例患者均在椎管减压后顺利置入Wallis系统。术中、术后未发生手术相关并发症。所有患者术后临床症状均有缓解，术后3天、1个月、6个月时ODI评分和VAS评分与术前比较，差异均有统计学意义（P＜0.01）。术后1个月、6个月邻近节段（腰3-4、腰5-骶1）椎间隙与椎间孔高度与术后3天比较，差异均无统计学意义（P＞0.05）。结论 椎管减压和Wallis棘突间动态内固定治疗老年节段性腰椎管狭窄症的术后短期随访临床效果满意，Wallis系统可有效维持手术节段椎间隙及椎间孔高度，短期随访未发现引起邻近节段明显退变。

Abstract:

Objective The aim of this study was to evaluate the short-term clinical outcomes of lumbar spinal canal decompression and Wallis interspinous dynamic stabilization for single-segmental lumbar spinal stenosis in the aged. Methods We retrospectively analyzed the data of 25 aged patients who suffered from the degenerative spinal stenosis of L4-5 and received spinal canal decompression and Wallis interspinous dynamic stabilization operation in Chinese PLA Air Force General Hospital during January 2008 to December 2010. There were 11 males and 14 females, with an average age of 65 years. The follow up period of every patient was not less than 6 months. We recorded the Oswestry dysfunction index(ODI) and visual analog score(VAS) preoperatively, at 3 days, 1 months and 6 months postoperatively and measured the height of intervertebral spaces and intervertebral foraminas of the operative segment(L4-5) and the adjacent segment(L3-4 and L5-S1) in the radiograph images. All the intraoperative and postoperative complications of every patient were also recorded. Results The Wallis systems were all successfully implanted after spinal canal decompression in total 25 cases. No operation-relatived complications happened. Every patient got symptomatic relief to some extent after the operation, with significant difference in ODI and VAS between preoperation and 3 days, 1 months and 6 months postoperatively. (P＜0.01). And there was no statistical difference in the height of intervertebral spaces and intervertebral foraminas of the adjacent segment(L3-4 and L5-S1) between 3 days and 1 months and 6 months postoperatively(P＞0.05). Conclusions Spinal canal decompression and Wallis interspinous dynamic stabilization for degenerative spinal stenosis in the aged can get satisfactory short-term clinical outcomes. The Wallis system is effective to keep the height of intervertebral space and intervertebral foramina of the operative segment, and no degeneration of the adjacent segments is observed in short-term follow up.