Coflex内固定术与PLIF术治疗腰椎管狭窄症的疗效对比  

A comparative study of Coflex interspinous internal fixation versus posterior interbody fusion used in the surgical treatment of degenerative lumbar spinal stenosis

作　　者：余将明[1] 朱云荣[1] 许鹏[1] 王会学[1] 蒋玉权[1] 许国华[1] 何海龙[1] 叶晓健[1] 

机构地区：[1]第二军医大学长征医院骨科,上海市200003

出　　处：《中国矫形外科杂志》2011年第11期885-888,共4页Orthopedic Journal of China

摘　　要：[目的]探讨采用Coflex棘突间动态内固定植入术与传统PLIF术治疗单节段腰椎管狭窄症的疗效并进行对比研究。[方法]术前准确定位手术减压节段后分别采用腰后路减压Coflex棘突间动态内固定植入术(Coflex组)及腰后路减压植骨融合内固定术(PLIF组)治疗单节段腰椎管狭窄症72例,观察两组手术时间、出血量及并发症的差异;术前、术后随访时分别采用VAS评分和ODI进行相关功能评价;通过影像学观察手术节段及上邻节段术前、术后屈伸活动度变化。[结果]两组患者术后VAS、ODI评分均较术前明显下降(P<0.01),术后功能恢复无明显差异(P>0.05),而Coflex组手术时间、出血量均较传统PLIF组减少(P<0.01);术后1年Coflex组手术节段活动度与术前相比减少(P<0.05),PLIF组上邻椎间运动幅度组较术前增加(P<0.05),而Coflex组稍减少,与术前相比无明显差异(P>0.05)。[结论]Coflex棘突间内固定技术治疗单节段腰椎管狭窄症疗效好,并且具有手术时间短,出血量小,能保留手术节段一定的活动度,对上邻节段活动度影响小等优点。[Objective] To investigate a comparative functional outcomes and radiologie findings between Coflex interspinous internal fixation and posterior interbody fusion along with pedicle screw used in the surgical treatment of single - segmental degenerative lumbar spinal stenosis. [ Methods] Seventy -two patients with degenerative lumbar spinal stenosis were treated by Coflex interspinous internal fixation （Coflex group） or posterior interbody fusion along with pedicle screw （PLIF group） randomly after accurate location. The operation time, blood loss and complication rates were studied, and the clinical effects were evaluatd according to Visal analogue scale and Oswestry disability indexes preoperatively and postoperatively at 3 and 12 months. After operation range of motion （ROM） in the instrumented and upper adjacent segments were measured by flexion - extension radiographs. [ Results ] Visal analogue scale and Oswestry disability indexes were significantly lower after operation than preoperative in both groups （P 〈0.01 ） , but the operative time and blood loss in the Coflex group were less than in the PLIF group （P 〈0. 01 ） . The range of motion （ROM） in the instrumented segments in Coflex group was reduced ＇after operation （P 〈0.05） . ROM at the upper adjacent segment in the PLIF group was increased significantly at one year after operation （ P 〈 0. 05 ） , but it had no significant differences in the Coflex group preoperatively versus postoperntively （ P 〉 0.05 ） . [ Conclusion ] Coilex interspinous internal fixation can yield satisfactory clinical outcome in the surgical treatment of single - segmental degenerative lumbar spinal stenosis, with shorter surgical time , less blood loss, retained a range of motion at surgical segmental and less influence on ROM of upper adjacent segment.

关 键 词：腰椎管狭窄症 COFLEX 棘突间动态内固定 手术治疗 

分 类 号：R687.3[医药卫生—骨科学]