腰椎棘突间置入动态内固定Coflex系统治疗中年腰椎旋转不稳：近期腰椎稳定性评价

背景：腰椎棘突间动态内固定Coflex系统主要用于治疗轻度腰椎管狭窄病例，其适应范围是否可有进一步的扩大？ 目的：观察腰椎棘突间动态内固定Coflex系统治疗中年腰椎旋转不稳的近期疗效。 方法：对腰椎旋转不稳的11例中年患者行Coflex内固定术,均为L4~5节段性不稳定。所有患者术前及术后均行日本骨科学会(JOA)评分；观测影像指标包括手术前术后椎间隙中立角，过伸角，过屈角和 L4~5活动度。观察手术时间，术中出血量。 结果与结论：全部患者随访6个月。Coflex置入时间平均72.6 min，平均出血85.7 mL。术后6个月随访时，JOA评分由术前14.45±2.42提高到21.00±2.24，差异有显著性意义(P < 0.05)。L4~5活动度由术前(13.18±2.04)°减少到(8.09±0.94)°，差异有显著性意义(P < 0.05)。提示腰椎棘突间动态内固定Coflex系统治疗中年腰椎旋转不稳的近期疗效良好，腰椎稳定性有明显提高，中远期疗效尚待观察。

Coflex interspinous process dynamic internal fixation for the treatment of middle-aged lumbar rotation instability: Short-term lumbar stability evaluation

BACKGROUND:Coflex interspinous dynamic internal fixation is mainly applied for degenerative lumbar spinal stenosis patients. It remains unclear whether the indication of Coflex can be enlarged. OBJECTIVE:To evaluate the early clinical results of Coflex interspinous dynamic internal fixation for middle-aged lumbar rotation instability. METHODS:A total of 11 middle-aged patients with lumbar rotation instability were treated with Coflex interspinous dynamic internal fixation. The operation levels were all at L4-5 segments. The Japanese Orthopaedic Association (JOA) questionnaires were assessed before and after operation. The radiological measurement included segmental intervertebral angles including neutral angle, flexion angle, extension angle and the range of motion (ROM) of L4-5 segments. The operating time and the blood loss during operation were also observed. RESULTS AND CONCLUSION:All the patients were followed up for 6 months. The average operating time was 72.6 minutes, and blood loss during operation was 85.7 mL. Compared with pre-operation, the JOA score of 6 months after operation were raised from 14.45±2.42 to 21.00±2.24 (P < 0.05), and the ROM of L_4-5 segment decreased from (13.18±2.04)° to (8.09±0.94)° (P < 0.05). Coflex device shows a good early result for the treatment of middle-aged lumbar rotation instability and improved intervertebral rotation instability, but the long-term outcomes and complications need further evaluation.