棘突间动态稳定装置Coflex预负荷置入后对腰椎矢状位序列影响的前瞻性研究  

Influence of pre-/non-load of posterior Coflex dynamic stabilization on lumbar sagittal sequences during treatment of degenerative lumbar stenosis:a perspective study

作　　者：刘玉增[1] 海涌[1] 杨晋才[1] 关立[1] 王朝君[1] 周立金[1] 祖丹[1] 逄川[1] 

机构地区：[1]首都医科大学附属北京朝阳医院骨科,北京100020

出　　处：《脊柱外科杂志》2012年第5期284-287,共4页Journal of Spinal Surgery

摘　　要：目的前瞻性分析预负荷、无预负荷Coflex内置物置入体内后对腰椎矢状位序列的影响。方法 2008年8月～2010年8月采用Coflex棘突间动态稳定装置治疗老年单节段腰椎椎管狭窄症病例59例,均为L4/L5病变。男性26例,女33例;年龄为46～63岁,平均57.8岁;平均随访6个月。随机分成2组,预负荷组21例,无负荷组38例。观察术前和术后6个月随访时腰椎中立位和屈伸侧位X线片序列变化。结果预负荷组固定节段活动度减小,2组比较差异有显著统计学意义(P<0.05)。预负荷组术后腰椎前凸角度减小,与无负荷组相比差异有统计学意义(P<0.05);2组腰椎活动度与术前相比无明显变化,2组间比较差异无统计学意义(P>0.05)。结论棘突间动态稳定装置Coflex加载一定的预负荷(术中适度撑开2～5 mm),维持Coflex内置物受压状态,可以增加对固定节段后伸的限制,而对腰椎序列无明显影响。Objective To study the influence of pre/non-load of posterior Coflex dynamic stabilization on lumbar sagittal sequences,perspectively.Methods Elder patients with spinal stenosis disease were treated by Coflex interspinous dynamic fixation system from August 2008 to August 2010.The trial was conducted with the L4/L5 segment of 59 patients（26 were male and 33 were female）,with an age of 46-63（mean 57.8 years）.The mean follow-up time was 6 months for patients.The patients were randomly divided into 2 groups,with 21 patients in the pre-load group and 38 in the non-load group.X-rays of the patient＇s lumbar were viewed in neutral position and lateral flexion-extention before and 6 months after operation.Results Compared with the non-load group,the mobility of the fixed segment using Coflex interspinous dynamic stabilization system was significantly decreased（P0.05）.The lumbar lordotic angle of the pre-load group was significantly reduced compared with the non-load group postoperatively（P0.05）.The postoperative lumbar spine mobility was not significantly different from that before operation in the 2 groups,and there was no significant difference between the 2 groups.Conclusion Coflex with pre-load（distract 2-5 mm during the operation） can maintain its compressive statement.Extension restriction of the fixed segment with Coflex is increased and there is no effect on the lumbar sagittal alignment.

关 键 词：老年人 腰椎 椎管狭窄 内固定器 活动范围 关节 

分 类 号：R681.533.2[医药卫生—骨科学]