摘要
[目的]回顾性研究非融合技术（Wallis）治疗伴有ModicⅠ型改变的巨大腰椎间盘突出症的临床疗效及影像学结果,观察腰背痛缓解程度及终板变化情况。[方法]2008年1月～2008年8月,共治疗26例腰椎间盘突出症伴Modic I型改变的患者,均为L4、5间隙。男10例,女16例;平均年龄38岁。所有病例均行椎间盘突出髓核摘除＋Wallis动态固定术。患者术前、术后3个月及末次随访时摄腰椎正侧位及动力位X线片,分别测量椎间盘前、后缘高度,椎间孔高度,观察术前及末次随访手术节段MRI T2加权像终板变化,同时进行Oswestry功能障碍评分（ODI）、疼痛视觉模拟评分（VAS）。术后平均随访24.2（20～29）个月。[结果]术后3个月及末次随访的ODI及VAS评分均较术前有明显下降（P〈0.001）,术后3个月时椎间盘后缘高度及椎间孔高度较术前明显增加（P〈0.05）,椎间盘前缘高度较术前略有增加（P〉0.05）,但末次随访时高度呈下降趋势。获得随访的20例MRI表现仅有2例手术节段终板退变为ModicⅡ型。[结论]棘突间撑开装置Wallis作为一种预防及治疗腰椎早期退变疾病的非融合技术,能有效缓解腰腿痛,一定程度上延缓病变节段椎间盘的退变,同时能较好的维持手术节段的椎间盘及椎间孔高度,远期疗效尚需长期的随访研究。
[Objective]In this retrospective study,interspinous process devices（Wallis） were used to treat patients with massive lumbar disc herniation with endplate degeneration,the clinical and radiological outcomes were assessed to examine the changes of Modic type and low back pain. [Methods]From January 2008 to August 2008,all included patients（n=26）were treated in the level L4、5.Male for 10,female for 16.Mean age of the patients were 38 years.VAS and ODI were used to evaluate severity of pain,lumbar anteroposterior,lateral X-ray films were used to measure radiographic changes.The following roentgenographic parameters were measured preoperatively and during follow-up：the anterior and posterior disc height,foraminal height.The patients were followed up for average 24.2months（range,20~29 months）.[Results]The VAS and ODI postoperatively decreased significantly（P0.001）compared with preoperatively.The posterior disc height and foraminal height increased significantly（P0.05）,but they decreased as the follow-up time prolonged.The anterior disc height did not change significantly over the entire follow-up period.There were 2 of 20 patients with Modic Type I degenerated to type Ⅱ.[Conclusion]Interspinous process devices Wallis surgery can relieve the symptom significantly after decompression and prevent the progression of initial degenerative disc disease of lumbar spinal segments after nucleotomy.Moreover,it can maintain the disc height and foraminal height.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2011年第5期382-385,共4页
Orthopedic Journal of China
关键词
棘突
非融合
腰椎间盘突出
终板
spinous process
nonfusion
lumbar disc herniation
endplate
