后路经椎弓根动态稳定Waveflex系统治疗腰椎间盘突出症的早期临床观察

摘要

目的:评估后路经椎弓根动态稳定系统(Waveflex)固定治疗腰椎间盘突出症的临床疗效.方法:对21例单节段腰椎间盘突出症患者行髓核摘除Waveflex椎弓根动态稳定系统内固定术,术后使用视觉模拟评分(visual analogue scale,VAS)和日本矫形外科学会(Japanese orthopaedic association,JOA)评分评估临床疗效,同时行影像学观察椎间隙高度、手术节段的活动度,手术及相邻节段椎间隙的退变情况.结果:所有患者术后随访20~42个月,平均32.8个月.末次随访时临床疗效评价优良率为90.5%.术后患者VAS、JOA评分均明显改善,术前与术后各时间点的评分差异有统计学意义(P<0.05),术后各时间点间评分差异无统计学意义(P>0.05).对L4/5和L5/S1间隙分别统计比较,两者术后椎间隙腹侧及背侧高度均较术前显著增加(P<0.05).手术节段活动度与术前比较明显减少(P<0.05),术后各时间点间比较差异无统计学意义(P>0.05).患者手术及相邻节段无继发性椎间隙狭窄、椎体增生及终板硬化表现.结论:椎弓根动态稳定Waveflex系统能增加并维持手术节段椎间隙高度,保留一定的活动性,是手术治疗腰椎间盘突出症的可行方法.%Objective:To evaluate the early clinical outcomes of dynamic internal fixation(Waveflex) for the treatment of lumbar disc herniation. Methods:A total of 21 patients with single segment lumbar disc herniation received operation of discectomy and dynamic internal fixation (Waveflex). Clinical outcomes were determined by using VAS and JOA score. Imaging examinations for intervertebral space, surgical segmental movement and adjacent level changes were obtained. Results:All patients were followed up and the mean period of follow up was 32.8 months(range, 20~42 months). The excel-lent and good rate was 90.5%. Postoperative VAS and JOA scores were significantly improved compared with those before surgery and the difference was statistically significant (P<0.05) while the difference between different time points after surgery was not statistically significant(P>0.05). For both L4/5 and L5/S1, after the surgery, the heights of the intervertebral space including dorsal and ventral intervertebral space height were significantly higher than those before operation(P<0.05), and the segmental range of motion was significantly reduced than that before surgery (P<0.05) while the difference between different time point after surgery was not statistically significant (P>0.05). In the follow-up evaluation, there was no sec-ondary disc space narrowing, vertebral endplate sclerosis or hyperplasia in the surgical and its adjacent segment. Conclu-sion:As a non-fusion dynamic stabilization system, Waveflex system was available to reserve segmental movement, increase and maintain intervertebral space height, and appeared to be an effective method for the surgical treatment of lumbar disc herniation.