棘突间Coflex固定系统治疗腰椎退行性疾病的疗效分析  

The analysis of the efficacy of Coflex interspinous fixation system in the treatment of lumbar degenerative diseases

作　　者：吴清涛[1] 王哲[1] 罗卓荆[1] 

机构地区：[1]第四军医大学西京医院脊柱外科,西安710032

出　　处：《中国骨与关节杂志》2012年第1期17-22,共6页Chinese Journal of Bone and Joint

基　　金：卫生行业科研专项项目(201002018)

摘　　要：目的总结分析腰椎棘突间Coflex固定系统治疗腰椎退行性疾病的疗效和术后椎间盘再突出原因。方法回顾性总结分析2008年12月至2011年1月40例采用棘突间Coflex固定系统治疗腰椎退行性疾病患者的临床资料,男16例,女24例,年龄39～77岁,平均58.3岁;后路单纯开窗减压+Coflex固定15例,开窗减压、髓核摘除+Coflex固定25例。采用Oswestry功能障碍指数(ODI)和腰腿痛视觉模拟评分(VAS)评价临床疗效。术前及术后随访均拍摄腰椎正侧位、过伸过屈位X线片,观察手术节段活动度(ROM)及椎间隙高度指数变化。症状缓解不明显患者行腰椎MRI检查。结果所有患者均获得6-24个月随访,平均11.2个月。ODI和VAS评分分别由术前的43.88±16.34和5.94±1.39降至末次随访的14.63±6.84和1.13±0.96,差别有统计学意义(P<0.05)。术前椎间隙活动度8.32±3.56,术后3.64±2.72,差别有统计学意义(p<0.05)。术后椎间隙高度指数有明显提升(P<0.05),随访末期椎间隙高度指数逐渐下降,与术前无明显统计学差异(P>0.05)。3例行单节段减压、椎间盘切除+Coflex固定患者术后6个月内原有症状加重,MRI检查提示有椎间盘再突出,再突出率7%;1例患者行翻修手术后症状缓解,2例患者行保守治疗后好转。结论棘突间Coflex固定系统治疗腰椎退行性疾患近期疗效显著,但术后有再突出风险,于术适应证及手术方式选择需慎重,术后指导不可忽视。Objective To summarize and analyze the efficacy of coflex interspinous fixation system in the treatment of lumbar degenerative diseases and the causes of postoperative disc re-herniation. Methods The clinical data of 40 patients with degenerative lumbar diseases who were treated with coflex interspinous fixation system from December 2008 to January 2011 were retrospectively summarized and analyzed. There were 16 males and 24 females, whose mean age was 58.3 years old （range; 39-77 years）. Simple posterior decompression＋coflex fixation were used in 15 patients and decompression＋discectomy＋coflex fixation in 25 patients. The oswestry disability index （ODI） and visual analogue scale （VAS） of lumbocrnral pain were used to evaluate the clinical efficacy. The anteroposterior, lateral, hyperextension and hyperflexion X-ray films of the lumbar spine were taken in the preoperative and postoperative follow-up. The range of motion （ROM） of the lumbar of the operational segments and changes in disc height index were observed. The patients without significant symptom relief were examined with lumbar spine MRI. Results All patients were followed up. The mean follow-up time was 11.2 months （range; 6-24 months）. The ODI index scores dropped from 43.88~16.34 preoperatively to 14.63~6.84 in the latest follow-up. The VAS scores dropped from 5.94~1.39 preoperatively to 1.13~0.96 in the latest follow-up. The differences were statistically significant （P〈0.05）. The intervertebral space ROM was 8.32~3.56 preoperatively and 3.64~2.72 postoperatively. The differences were statistically significant （P〈0.05）. The disc height index had a significant increase postoperatively （P〈0.05）. The index of the disc height was gradually decreased at the end of the follow-up. The differences were not statistically significant comparing with the preoperative data （P〉0.05）. Within 6 months postoperatively, original symptoms aggravated in 3 cases receiving single segment decompression and intervertebral di

关 键 词：腰椎 退变性疾病 COFLEX 棘突间固定 再突出 

分 类 号：R687.3[医药卫生—骨科学]