Coflex与PLIF治疗腰椎退行性疾患的对比研究

目的比较棘突间非融合弹性内固定术(coflex system)与后路椎间融合固定术(posterior lumbar interbody fusion,PLIF)治疗单节段腰椎退行性疾病的疗效。方法收集苏州大学附属第一医院骨科2007年10月至2009年10月接受coflex治疗患者45例,男22例,女23例,年龄29~70岁;接受PLIF治疗患者50例,男24例,女26例,年龄31~75岁。手术前后及末次随访均采用视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(oswestry disability index,ODI)、日本骨科协会(Japanese orthopaedic association,JOA)进行疼痛功能评分和临床疗效评价;摄腰椎正侧位和动力位片,测量椎间隙高度,手术节段活动度及邻近上下节段活动度。结果手术时间coflex组(66.8±4.8)min,PLIF组(117.8±7.2)min;术中出血coflex组(78.9±7.4)mL,PLIF组(134.2±11.3)mL,两组相比差异有统计学意义。术前及末次随访coflex组VAS、ODI、JOA评分与PLIF组比较,差异无统计学意义。末次随访手术节段(L4~5)活动度coflex组(7.47±1.66)°,PLIF组(1.07±0.53)°;邻近节段L3~4、L5S1活动度,coflex组(10.42±2.19)°、(8.07±1.68)°,PLIF组(11.86±2.88)°、(9.12±2.07)°;两组相比差异有统计学意义(P0.05)。末次随访coflex组有2例腰痛,1例下肢麻木;PLIF组有3例腰痛,差异无统计学意义(P0.05)。结论非融合动态稳定技术可以在创伤小、并发症少的前提下取得与融合术同样的临床疗效,并且由于植入后对邻近节段的应力小,减少了邻近节段的退变和复发可能,可以替代腰椎融合术治疗轻中度的腰椎退行性疾病。

A Comparative Study of the Clinical Efficacy of Coflex and PLIF in the Treatment of Lumbar Degenerative Diseases

Objective To compare the outcome of interspinous nonfusion dynamic internal fixation （coflex） and posterior lumbar interbody fusion （PLIF） in the treatment of lumbar degenerative diseases. Methods From October 2007 to October 2009,95 patients with single lumbar degenerative diseases were treated with coflex or PLIF. In the coflex group,22 males and 23 females with a mean age of 49.5 years were included. In the PLIF group, there were 24 males and 26 females with a mean age of 50.4 years. The VAS, ODI and JOA score were assessed before and after operation. The intervertebral space height and the mobility of the operative and adjacent segments were determined according to the X-ray results. Results The mean opera- tion time was （66.8 ± 4.8 ） rain in coflex group and （ 117.8 ± 7.2 ） rain in PLIF group （ P 〈 0.05 ）. The mean intraoperation bloodloss differed significantly, （ 78.9 ± 7.4 ） mL in coflex group compared with （ 1 34. 2 ± 1 1 . 3 ） mLinPLIFgroup （ P 〈 0. 05 ） . The mobility ofoperation segment was （ 7.47 ± 1. 66 ） o in coflex group and （ 1.07 ± 0. 53 ） ~ in PLIF group （ P 〈 0.05 ）. Meanwhile, the mobility in adjacent levels in coflex group was significant higher than that in PLIF group. However, there was no significant difference with regard to VAS, ODI and JOA scores between the two groups （ P 〉 0. 05 ）. Low back pain was observed in two patients of the coflex group and in three of the PLIF group during the follow up period, with no statistical differ- ence between the two groups. There was one patient suffering from numbness during the follow up period in coflex group,which was not frod in PLIF group. Conclusion Lumbar degenerative diseases can be treated successfully with coflex and PLIF. There is no significant difference in complications and functional outcome between the two groups. However, coflex takes advan- tages of less operation time,less blood loss and higher mobility of operative and adjacent segments over PLIF.