摘要
目的:总结腰椎后路椎间融合术联合Coflex动态固定术治疗腰椎退行性疾病的临床疗效。方法:对2008年3月至2010年3月应用腰椎后路椎间融合术联合Coflex动态固定治疗的18例腰椎退行性疾病患者(均为双节段)的临床资料进行回顾性总结分析。男11例,女7例;年龄41～62岁,平均50.2岁。分析内容包括:ODI指数、腰痛和下肢痛的VAS评分,并通过腰椎动力位X线观察活动度(ROM)、椎间隙高度(DHI)的变化情况。结果:所有患者获得随访,时间6～30个月,平均12个月。在末次随访时,腰痛VAS评分、下肢痛VAS评分及ODI指数均较术前明显改善(P<0.001)。腰痛VAS评分术前(7.20±0.90)分,末次随访(1.50±0.90)分;下肢痛VAS评分术前(5.20±0.90)分,末次随访(1.10±0.80)分。ODI指数术前(52.50±5.90)%,末次随访(15.90±5.80)%。Coflex置入节段的DHI术前0.23±0.05,术后0.35±0.06,末次随访0.33±0.04,椎间隙高度未见明显丢失。Coflex置入节段的ROM术前(8.90±1.80)°,术后降至(8.30±1.90)°,末次随访(8.10±1.80)°,与术前差异无统计学意义(P=0.19),Coflex置入节段活动度未见明显改变。L2-S1ROM术前为(20.20±5.60)°,术后(14.40±5.70)°,末次随访(15.50±5.20)°,与术前比较有统计学差异(P=0.01)。结论:腰椎后路椎间融合术联合Coflex动态固定治疗双节段腰椎退变性疾病能取得满意的中短期临床疗效,但没有充分证据证明这项技术优于多节段融合术。手术适应证的合理选择十分重要。
Objective：To summarize the effect of the implantation of Coflex interspious stabilization device combined with spinal fusion for the treatment of lumbar degenerative disease.Methods：From March 2008 to March 2010,18 patients with two levels lumbar degenerative disease were treated with spinal fusion and dynamic interspinous fixation with Coflex system.There were 11 males and 7 females.The average age was 50.2 years（range 41 to 62 years）.The VAS and the Oswestry Disability Index（ODI） were used to assess clinical symptoms preoperatively and postoperatively.All patients underwent flexion/extension radiographs examinations before surgery and at last follow-up.Range of motion（ROM） and disc height index（DHI） were recorded.Results：All patients were followed up for 12 months averagely（range 6-30 months）.At final follow-up,leg VAS,back VAS and ODI functional score were significant improved than those of preoperation [back VAS：1.50±0.90 vs 7.20±0.90;leg VAS：1.10±0.80 vs 5.20±0.90;ODI functional score：（15.90±5.80）% vs（52.50±5.90）%].The DHI increased from 0.23±0.05 preoperatively to 0.35±0.06 postoperatively and to 0.33±0.04 at final follow-up,the height of intervertebral space were not found significant loss.The ROM at the Coflex stabilized levels on the X-ray views was（8.90±1.80）° preoperatively,（8.30±1.90）° postoperatively,and（8.10±1.80）° at final follow-up.There was no significant difference between final follow-up and preoperative（P=0.19）.The ROM of the lumbar spine（L2-S1） was（20.20±5.60）° preoperatively,（14.40±5.70）° postoperatively,and（15.50±5.20）° at final follow-up.There was significant reduction of the L2-S1 ROM at final follow-up（P=0.01）.Conclusion：Posterior interspinous stabilization with Coflex system combined with spinal fusion can obtain satisfactory outcomes for patients with two levels lumbar degenerative disease in the short follow-up duration.Nevertheless,no overwhelming evidence suggested that the system is better than traditional fusion at present.The selection of surgical indication is important for the treatment of lumbar degenerative disease.
出处
《中国骨伤》
CAS
2011年第4期277-281,共5页
China Journal of Orthopaedics and Traumatology
基金
上海市科委医学重点项目(编号:09411952900)~~
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
Lumbar vertebrae
Degenerative disease
Spinal fusion
Spinal non-fusion
Dynamic fixation
