| Coflex棘突间动态内固定治疗退行性腰椎间盘疾病的临床分析 |
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Received:January 18, 2011
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| 期刊信息：《中国骨伤》2011年24卷，第4期，第291-294页 |
| DOI：10.3969/j.issn.1003-0034.2011.04.007 |
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目的：比较Coflex棘突间动态内固定和后路腰椎椎体间融合(PLIF)术治疗退行性椎间盘疾病的临床疗效。
方法：对2007年1月至2010年1月收治的42例退行性椎间盘疾病患者进行回顾性分析, 其中男19例, 女23例；年龄33～62岁, 平均(46.5±8.5)岁；病程6个月～7年, 平均36个月。X线片或CT影像学显示42例患者均为L4,5单节段病变, 其中单纯腰椎间盘突出症14例, 合并腰椎管狭窄症28例。42例患者分别采用Coflex棘突间动态内固定 (非融合组, 21例)和PLIF术(融合组, 21例)进行治疗。采用日本整形外科学会(JOA)评分和ODI指数对临床疗效进行评价, 通过X线片测量腰椎各间隙活动度(ROM), 并比较两组的手术时间、出血量、术后住院时间。
结果：两组患者均获得随访, 时间至少10个月, 非融合组10个月随访时JOA评分由术前13.8±3.7提高至24.6±4.6(P<0.01), ODI由术前65.8±7.5降低至25.6±5.1(P<0.01), L4,5节段活动度由术前4.2±0.7增加至5.3±0.6(P<0.01).而融合组10个月随访时JOA评分由术前13.2±3.2提高至24.5±4.3(P<0.01), ODI由65.5±8.2降低至26.5±6.1(P<0.01), L4,5节段活动度丧失。非融合组手术时间(71.2±12.8) min 、出血量(56.6±25.5) ml 、术后住院天数(4.4±1.3) d同融合组手术时间(121.0±23.2) min 、出血量(135.8±19.8) ml及术后住院天数(12.6±2.4) d相比, 均存在统计学差异(P<0.01).随访期间未发现与Coflex装置本身的并发症。
结论：与后路腰椎椎体间融合术相比, Coflex棘突间动态内固定治疗退行性椎间盘疾病具有安全性高、创伤小、能够保留一定的腰椎活动度, 在预防相邻节段椎间盘退变方面有一定作用。 |
| [关键词]:腰椎 退行性疾病 脊柱融合术 脊柱非融合术 动态固定 |
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| Clinical analysis of interspinous dynamic internal fixation with the Coflex system in treating lumbar degenerative disease |
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Abstract:
Objective: To campare the clinical effects between interspinous dynamic internal fixation with Coflex system and posterior lumbar interbody fusion in treating lumbar degenerative disease.
Methods: From Jan. 2007 to Jan. 2010, 42 patients with lumbar degenerative disease were treated with interspinous dynamic internal fixation with Coflex system (non-fusion group, 21 cases) and posterior lumbar interbody fusion(fusion group, 21 cases), including 19 males and 23 females with an average age of (46.5±8.5)years(range, 33 to 62 years). The range of course of disease was from 6 to 84 months with an average of 36 monthes. All pathological changes were single segment in L4,5 by X-ray films or CT scanning, among them, single lumbar disc herniation was in 14 cases, combined with lumbar spinal stenosis in 28 cases. The clinical effects of all patients were evaluated according to Japanese orthopeadic association (JOA, 29 points) and Oswestry disability index(ODI); range of motion(ROM) of lumbar segments were measured by X-ray films;operative time, intraoperative blood loss, hospital stay were compared between two groups.
Results: All patients were followed up for 10 months at least. In non-fusion group, JOA increased from 13.8±3.7 preoperatively to 24.6±4.6 at final follow-up(P<0.01);ODI decreased from 65.8±7.5 to 25.6±5.1(P<0.01), ROM improved from 4.2±0.7 to 5.3±0.6 at L4,5(P<0.01). In fusion group, JOA increased from 13.2±3.2 preoperatively to 24.5±4.3 at final follow-up(P<0.01);ODI decreased from 65.5±8.2 to 26.5±6.1(P<0.01);all ROM at L4,5 had lose (decreased from 4.2±3.2 to 0). There were significant differences in the operative time, intraoperative blood loss, hospital stay between two groups(P<0.01), in non-fusion group was respectively(71.2±12.8) min, (56.6±25.5) ml, (4.4±1.3) d and in fusion group was respectively(121.0±23.2) min, (135.8±19.8) ml, (12.6±2.4) d. No complications were found with the Coflex system.
Conclusion: Interspinous dynamic internal fixation with Coflex system in treating lumbar degenerative disease is better than that of posterior lumbar interbody fusion in some aspects. Coflex system have high safety, less trauma, and can reserve lumbar mobility, which is effective in preventing adjacent intervertebral disc degeneration. |
| KEYWORDS:Lumbar vertebrae Degenerative disease Spinal fusion Spinal non-fusion Dynamic fixation |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 都芳涛.Coflex棘突间动态内固定治疗退行性腰椎间盘疾病的临床分析[J].中国骨伤,2011,24(4):291~294 |
| 英文格式: | DU Fang-tao.Clinical analysis of interspinous dynamic internal fixation with the Coflex system in treating lumbar degenerative disease[J].zhongguo gu shang / China J Orthop Trauma ,2011,24(4):291~294 |
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