| BackgroundPosterior lumbar interbody fusion (PLIF), as a gold standard for the treatment of lumbar disc herniation, has been widely applied clinically. The problems resulted from lumbar disc herniation (LDH) are gaining wider and wider social concern. In orthopedic field, how to eliminate the compression by herniated disc on the nerve root and relieve the clinical symptoms and meanwhile maintain the stability of physiological function of the lumbar spine after the operative treatment for lumbar disc herniation has become an urgent problem in spine surgery. Given the situation, lumbar non-fusion technologies (Wallis) emerges at the right moment. In the thesis, the writer is committed to explore the clinical feasibility of lumbar non-fusion technologies (Wallis).ObjectivesThe thesis delves into the curative effects respectively by using non-fusion interspinous lumbar fixation technique (Wallis) and lumbar interbody fusion (PLIF) in the treatment of the disease caused by lumbar disc degeneration and aims to decide an ideal surgery remedy by comparison.Methods1、There were altogether32cases (24females&8males, aged36to68, duration of6months to11years) using either non-fusion interspinous lumbar fixation technique (Wallis) or lumbar interbody fusion (PLIF). Under each therapy, there were6cases with spinal stenosis and disc herniation,6cases with lumbar instability combined lumbar disc herniation and4cases with simple lumbar disc herniation. 2、After careful communication with the patients and their families according to their medical orders, the writer divided them into two groups upon receiving their permission. Gender ratio of the two groups was parallel and the discrepancy of their average age was less than8years. The general illness was similar and no statistically significant difference (P>0.05) exists. In Wallis group, there were16patients (4males&12females; aged from36to66,51on average; duration of9months to6years,40.5months on average). In PLIF group, there were16patients (4males&12females; aged from40to68,54on average; duration from1year to10years,66months on average). Routine postoperative wound negative pressure was24-48h. Treatment according to symptoms and postoperative rehabilitation training were accompanied. Review after the surgery was needed, and the rectification of lumbar spine, the lateral X-ray, and the dynamic X-ray film of flexion and hyperextension were all necessary.3、The used time, blood loss, VAS score, ODI index, the excellent-good rate and intervertebral activity rate (ROM) were observed in the two groups. The common used tatistical software SPSS17.0was also adopted.Results1、All the surgeries went smoothly and the vital signs of the patients were all stable. No complications appear during and after the surgery. Surgery time:Wallis group took50-75minutes (62.5minutes on average) and PLIF group took102-135minutes (118.5minutes on average). Differences of surgery time between the two groups was statistically significant (P<0.05). Intraoperative blood loss:Wallis Group lost80-100ml (90ml on average) and PLIF group lost350～700ml (525ml on average). Differences of blood loss between the two groups were statistically significant (P<0.01).2、The surgical excellent-good rate could be referred to Odom standard. EXCELLENT was the Wallis group with12cases and the PLIF group with13cases; GOOD was the Wallis group with2cases and PLIF group with2patients; AVALIABLE was the Wallis group with2cases and the PLIF group with1patients; POOR existed neither of the two groups. Of all the cases,32cases were followed up for a period of6to24months,18months on average, taking the last follow-up as a basis for evaluation. During and between the surgery stages, no stenosis and degenerative spondylolisthesis and other degeneration phenomenon were found during the follow-ups, neither were the pedicle screw loosening, fracture and lumbar instability performance. No obvious degeneration was shown in the X-ray films of Wallis group and the degeneration was physiologically and physically natural. X-ray films of PLIF group showed good fusion of problematic bone grafts, without the instantaneous formation of pseudoarticulation, which was in a slow progressive degenerative trend.3、Postoperation. As for the Wallis group, VAS has been decreased to2.8±1.4, ODI to23±1.5and the ROM surgical segment to19.32±1.35°, while the adjacent segmental ROM remained intact. As for the PLIF group, VAS dropped to5.8±1.4and ODI to21±1.5, while the adjacent segmental ROM increased and the segmental fusion was steady. The built-in state of both the Wallis group and the PLIF group tended to stabilize.Conclusions1、Early satisfactory curative effect can be obtained by both Wallis method and PLIF method;2、Compared with the PLIF method, Wallis method causes smaller trauma and can keep the intervertebral within the range of motion, thus is conducive to prevent degeneration acceleration;3、Within its range of indications, the Wallis method is an ideal surgical approach to treat lumbar discogenic degenerative disease. |
PDF Full Text Request