棘突间动态稳定装置Coflex植入并发症的探讨  

Device implanted complications of Coflex interspinous dynamic stabilization

作　　者：藏磊[1] 海涌[1] 苏庆军[1] 鲁世保[1] 张岑山[1] 杨晋才[1] 关立[1] 康南[1] 孟祥龙[1] 刘铁[1] 杜鹏[1] 

机构地区：[1]首都医科大学附属北京朝阳医院骨科,100020

出　　处：《中华外科杂志》2012年第9期782-787,共6页Chinese Journal of Surgery

摘　　要：目的探讨腰椎棘突问动态稳定装置Coflex植入术中、术后的假体植入并发症及其应对策略。方法对2008年9月至2010年8月133例行Coflex植入的腰椎退变性疾病患者进行回顾性研究，男性62例，女性71例；年龄35～81岁，平均60．8岁。其中出现Coflex植入并发症者13例，男性6例，女性7例；年龄41～71岁，平均58．6岁。分析Coflex植入并发症并根据不同的特点采用相应的治疗策略，对并发症患者术前、术后、保守治疗后及末次随访的视觉模拟量表（VAS）评分和Oswestry功能障碍指数（ODI）评分结果及疗效相关指标进行配对t检验。结果13例Coflex植入并发症及其治疗包括：术中棘突断裂而改行椎弓根螺钉内固定融合3例；术后复查或随访中发现棘突断裂者2例，其中再手术椎弓根螺钉内固定融合者1例，保守治疗者1例；术前手术节段存在退变性冠状面椎间滑移者4例，矢状面不稳定者1例，术后随访中发现Coflex假体位置上移者1例患者，均有明显的疼痛加重症状并经保守治疗；1例患者术中因Coflex假体植入节段错误而改行椎弓根螺钉内同定融合；1例术后不明原因症状加重行再手术Coflex假体取出及椎弓根螺钉内固定融合。13例患者术后随访20～38个月，平均27．6个月；其中7例Coflex假体植入术后出现腰腿痛症状加重但Coflex假体位置仍可维持的患者，经保守治疗后末次随访VAS评分为1．9±0．7、ODI评分为23．2±3．4，较术前的6．1±1．1和58．1±3．0有明显改善（t=8．2和18．2，P〈0．01）；2例经再手术椎弓根螺钉翻修的Coflex植入并发症患者，其VAS及ODI评分亦有改善。结论Coflex不宜应用于骨质疏松、棘突间距过小及椎间冠状面滑移或矢状面不稳定的病例；而假体的选择、植入深度及加持固定的力量均应适度。对于出现症状但Coflex假体位置尚能维持者，可行保守治疗；但对于假体�Objective To investigate device implanted complications and corresponding therapeutic strategies of Coflex interspinous dynamic stabilization system for lumbar spine intraoperatively and postoperalively. Methods From September 2008 to August 2010, 133 cases of degenerative disease of lumbar spine including 62 males and 71 females, ranging from 35 to 81 years of age （mean 60. 8 years） , underwent or planed to be underwent decompression with Coflex interspinous dynamic stabilization system were reviewed retrospectively, and 13 cases including 6 males and 7 females, ranging from 41 to 71 years of age （mean 58.6 years） , occurred device implanted complications. The Coflex implanted complications were analyzed, and therapeutic strategies according to different character were carried out, scores of visual analogue scale （VAS）, Oswestry disability index （ODI） and effect-related data preoperatively, postoperatively, after conservative treatment and in final follow-up were evaluated with paired-samples t test. Results Thirteen cases of Coflex implanted complications and treatment applied included： 3 cases occurred fracture of spinous processes intraoperatively were treated by pedicle screws instead; 2 cases occurred fracture of spinous processes postoperatively or during follow-up, including 1 case underwent revision with pedicle screws, another 1 case treated with conservative treatment; 4 cases with degenerative coronal spondylolysis in surgical segments, 1 case with sagittal instability preoperatively, and 1 case with device dislodgment in follow-up all suffered aggravated pain and received conservative treatment; 1 case suffered implanted malposition intraoperatively was underwent internal fixation with pedicle screws instead; at length, 1 case with aggravated pain postoperatively and without definite reason received revision with internal fixation of pedicle screws demolishing the Coflex. The follow-up time of 13 cases ranged from 20 to 38 months （ mean 27.6 months） ; and 7 cases implanted Cofle

关 键 词：腰椎 椎间盘 内固定器 假体植入 手术中并发症 手术后并发症 

分 类 号：R687.3[医药卫生—骨科学]