Coflex腰椎棘突间动态稳定系统手术并发症分析

 目的 探讨Coflex腰椎棘突间动态稳定系统治疗退行性腰椎间盘疾病的手术并发症及治疗措施。方法 回顾性分析2007年11月至2011年6月采用Coflex内固定手术治疗121例退行性腰椎疾病患者资料，男76例，女45例；年龄37~75岁，平均54.6岁。其中单节段腰椎管狭窄症38例，单节段腰椎间盘突出症58例，双节段腰椎管狭窄症15例，双节段腰椎间盘突出症10例；病变节段均分布于L3，4、L4，5及L5S1间隙。记录并分析手术相关并发症及转归。结果 10例患者出现手术相关并发症，其发生率为8.3%(10/121)。其中器械直接相关并发症3例，包括假体固定翼折断、假体松动及棘突骨折各1例，予观察随访，假体均未移位，未影响手术疗效。非器械相关并发症7例：术中硬膜撕裂2例，创口浅表感染1例，经相应处理均治愈；再手术4例，再手术率为3.3%(4/121)，其中2例为术中减压不彻底需再次减压，1例为椎间盘突出术后复发再次行髓核摘除术，另1例为术后椎管内血肿形成经手术清除血肿后好转。结论 Coflex 辅助治疗退行性腰椎疾病手术并发症发生率及再手术率均较低，且器械直接相关并发症较低，术中规范操作是降低器械直接相关并发症的关键；而严格掌握手术适应证、术中彻底有效减压是保证手术疗效、避免发生非器械相关并发症的关键。

Clinical evaluation of complications related to Coflex interspinous process device for degenerative lumbar disc diseases

Objective To investigate complications associated with Coflex interspinous process device for degenerative lumbar disc diseases and methods to treat. Methods Clinical data of 121 patients with degenerative lumbar disc diseases, who had undergone surgical decompression and additional fixation of Coflex between November 2007 and June 2011, was analyzed retrospectively. There were 76 males and 45 females, aged from 37 to 75 years (average, 54.6 years). Surgery-related complications and sequelae were recorded and analyzed. Results Surgery-related complications occurred in 10 patients, and the incidence was 8.3%(10/121). There were 3 cases of device-related complications, including wing break in 1 case, prosthetic loosening in 1 case and spinal process fracture in 1 case; all 3 cases were treated conservatively and received good results. There were 7 cases of non-device-related complications, including dura mater dilaceration in 2 cases, superficial wound infection in 1 case, insufficient decompression of spinal canal in 2 cases, recurrence of disc herniation in 1 case, and intraspinal hematoma in 1 case; the former 3 patients recovered after corresponding treatment, and the latter 4 patients also recovered after re-operation. Conclusion The incidences of complications and re-operation associated with application of Coflex are low, and the incidence of device-related complications is also low. The precise intraoperative manipulation is the key to reduce incidence of device-related complications. It's absolutely necessary to strictly master surgical indications and perform sufficient decompression in order to receive good surgical results and avoid non-device-related complications.