腰椎棘突间非融合动态稳定技术CoflexCoex与KMC的近期疗效比较  

A COMPARATIVE STUDY ON EARLY CLINICAL OUTCOME BETWEEN Cofl ex AND KMC FOR SINGLE-LEVEL DEGENERATIVE LUMBAR SPINAL DISORDERS

作　　者：姚依村 梁伟国[1] 吴劲风[1] 周子强[1] 陈志光[1] 叶韶晖[1] 李锋生[1] 叶冬平[1] 

机构地区：[1]暨南大学医学院第四附属医院广州市红十字会医院骨科,广州510220

出　　处：《中国修复重建外科杂志》2014年第4期474-479,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：广东省自然科学基金面上项目(10151022001000005);广州市医药卫生科技重点项目(2008-ZDi-15、2009-ZDi-04)~~

摘　　要：目的 比较棘突间稳定器KMC动力重建与Coflex植入治疗腰椎间盘退行性疾病的临床疗效与影像改变,评估KMC对腰椎间盘退行性疾病的近期疗效。方法 2011年5月-2012年7月共收治33例符合选择标准的腰椎间盘退行性疾病患者,按随机双盲方法分为Coflex组（19例）和KMC组（14例）,均为单节段棘突间动态稳定系统植入。两组患者年龄、性别构成、病程、病变节段及疾病诊断构成等一般资料比较,差异均无统计学意义（P〉0.05）,具有可比性。记录两组手术时间、术中失血量、术后卧床时间及住院天数。术前和末次随访时,采用Oswestry功能障碍指数（ODI）和疼痛视觉模拟评分（VAS）进行临床疗效评估;在腰椎X线片上测量并比较两组手术节段椎间隙高度及椎间孔高度和宽度,测量手术节段和上一邻近节段活动度评估腰椎活动功能变化。结果 两组患者手术时间、术中失血量、术后卧床时间及住院天数等比较差异无统计学意义（P〉0.05）。33例均获随访,Coflex组随访时间12～24个月,平均16.2个月;KMC组12～26个月,平均17.9个月。随访期间两组患者均未发现内固定物移位、松动或断裂等并发症。末次随访时两组患者ODI和VAS评分均较术前显著下降（P〈0.05）;术前及末次随访时两组评分及末次随访时评分改善率比较差异均无统计学意义（P〉0.05）。两组患者末次随访时除椎间隙前高与术前比较差异无统计学意义（P〉0.05）外,椎间隙中高、椎间隙后高、椎间孔高度和宽度均较术前显著增加（P〈0.05）;术前及末次随访时两组间各指标比较差异均无统计学意义（P〉0.05）。末次随访时两组手术节段活动度均较术前显著改善（P〈0.05）,上一邻近节段活动度与术前比较差异无统计学意义（P〉0.05）。术前及末次随访时两组手术节段及上一邻近节段活动度比较差异均无统计学意义（P〉0.05Objective To compare the effectiveness and radiological changes between KMC interspinous dynamic reconstruction and Coflex for degenerative lumbar spinal disorders and evaluate the clinical outcome of the KMC interspinous dynamic internal fixation for degenerative lumbar spinal disorders. Methods A randomized controlled double-blind trial was conducted. Thirty-three patients with degenerative lumbar spinal disorders were divided into 2 groups between May 2011 and July 2012, 19 patients received Coflex treatment （group A）, and 14 patients received KMC （group B）. Single Coflex or KMC fixation was used. There was no significant difference in age, gender, disease duration, affected segment, and disease diagnosis between 2 groups （P 〉 0.05）. The Oswestry disability index （ODI） score and visual analogue scale （VAS） score were used to evaluate the effectiveness. The anterior disc height, middle disc height, posterior disc height, and foramen intervertebral height and width of operated segment were measured and compared between at preoperation and last follow-up on the X-ray films. Range of motion （ROM） of operated segment and adjacent segment was measured. Results There was no significant difference in operation time, intraoperative blood loss, postoperative recovery time, and hospitalization time between 2 groups （P 〉 0.05）. The patients were followed up 12-24 months （mean, 16.2 months） in group A and 12-26 months （mean, 17.9 months） in group B. No shift, loosening, or breaking of internal fixation occurred. The ODI score and VAS score were significantly decreased at last follow-up when compared with preoperative scores （P 〈 0.05）; there was no significant difference in the ODI score and VAS score at preoperation and last follow-up, and in improvement rate at last follow-up between 2 groups （P 〉 0.05）. The middle disc height and posterior disc height, and foramen intervertebral height and width were significantly increased when compared with preoperative ones （P 〈

关 键 词：腰椎间盘退行性疾病 非融合动态稳定技术 内固定 

分 类 号：R687.3[医药卫生—骨科学]