Wallis棘突间动态稳定系统治疗腰椎间盘突出症的研究进展及其与融合术和显微减压术 的比较

Research Progress of the Wallis Interspinous Dynamic Stabilization System for Lumbar Disc Herniation and Its Comparison with Fusion Surgery and Microdecompression

摘要: 腰椎间盘突出症(lumbar disc herniation, LDH)是导致下腰痛及下肢放射痛的常见退行性脊柱疾病，严重影响患者生活质量。对于保守治疗无效者，手术干预仍是主要治疗方式。传统后路椎间融合术在缓解疼痛及改善功能方面疗效确切，但以牺牲节段活动度为代价，可能改变脊柱正常的力学传导模式，并增加邻近节段退变(adjacent segment disease, ASD)的发生风险。显微镜下腰椎间盘切除术等微创减压技术通过充分神经减压获得良好的短期疗效，但对椎间隙高度及节段稳定性的改善有限。在此背景下，以Wallis系统为代表的棘突间动态稳定装置逐渐受到关注。该装置通过置入棘突间间隔物并配合张力带固定，在限制异常运动的同时保留手术节段的部分生理活动度，旨在减压与稳定之间取得平衡。近年来，关于Wallis动态稳定系统的生物力学特性、临床疗效及影像学改变的研究逐渐增多。本文通过检索PubMed及中国知网等数据库，对近年来有关Wallis动态稳定系统治疗腰椎间盘突出症的研究进行系统梳理，重点综述其结构设计与生物力学基础、临床疗效、影像学改变、邻近节段影响及并发症情况，并与传统融合术及显微镜下腰椎间盘切除术进行比较分析。现有研究表明，Wallis系统在疼痛缓解及功能改善方面与传统融合术及微创减压术总体相当，同时在保留手术节段活动度、维持椎间隙高度及改善节段应力分布方面具有一定优势，可能对延缓邻近节段退变具有潜在价值。然而，其长期疗效、邻近节段保护作用及适应证选择仍存在一定争议。综上，Wallis动态稳定系统作为介于单纯减压与融合术之间的“非融合”治疗策略，为部分腰椎间盘突出症患者提供了一种兼顾疗效与功能保留的治疗选择。未来仍需更多高质量、多中心及长期随访研究，以进一步明确其临床定位及适应证。

Abstract: Lumbar disc herniation (LDH) is a common degenerative spinal disease that leads to low back pain and lower limb radiation pain, which seriously affects the quality of life of patients. For those who are ineffective in conservative treatment, surgical intervention is still the main treatment. Traditional posterior interbody fusion is effective in relieving pain and improving function, but at the expense of segmental mobility, it may change the normal mechanical conduction mode of the spine and increase the risk of adjacent segment degeneration (ASD). Minimally invasive decompression techniques such as lumbar discectomy under microscope have achieved good short-term results through sufficient nerve decompression, but the improvement of intervertebral space height and segmental stability is limited. In this context, the dynamic stabilization device between spinous processes, represented by Wallis system, has gradually attracted attention. By inserting interspinous spacer and fixing it with tension band, the device can limit abnormal movement while retaining part of the physiological activity of the surgical segment, aiming at achieving a balance between decompression and stability. In recent years, the research on biomechanical characteristics, clinical efficacy and imaging changes of Wallis dynamic stabilization system has gradually increased. In this paper, by searching PubMed and CNKI databases, the research on the treatment of lumbar disc herniation with Wallis dynamic stabilization system in recent years was systematically sorted out, focusing on its structural design, biomechanical basis, clinical efficacy, imaging changes, influence of adjacent segments and complications, and compared with traditional fusion and lumbar disc resection under microscope. The existing research shows that Wallis system is generally equivalent to traditional fusion and minimally invasive decompression in terms of pain relief and function improvement, and has certain advantages in preserving the mobility of surgical segments, maintaining the height of intervertebral space and improving the stress distribution of segments, which may have potential value in delaying the degeneration of adjacent segments. However, there are still some disputes about its long-term efficacy, the protective effect of adjacent segments and the choice of indications. To sum up, Wallis dynamic stabilization system, as a “non-fusion” treatment strategy between simple decompression and fusion, provides a treatment option for some patients with lumbar disc herniation with both curative effect and functional preservation. More high-quality, multi-center and long-term follow-up studies are needed in the future to further clarify its clinical location and indications.