Coflex棘突间动力内固定装置植入治疗老年退行性腰椎管狭窄症临床观察

目的 探讨Coflex棘突间动力内固定装置植入治疗腰椎管狭窄的疗效和安全性.方法 83例腰椎管狭窄患者随机分为2组,获得随访80例.Coflex组(38例)应用Coflex植入治疗,PLIF组(42例)应用后路腰椎椎体间融合术(PLIF)治疗.比较2组手术创伤程度指标(手术时间、术中出血量、48 h内伤口引流量、术后3 d切口疼痛程度VAS评分、术后下地活动时间)及临床疗效指标(腰部及下肢疼痛VAS评分、采用13本矫形外科协会JOA评分、Oswestry功能障碍指数ODI评分),椎间隙高度及椎管矢状径(MSD).结果 手术时间[(104.3±9.5)、(174.6±24.2)min]、术中出血量[(230.7±29.6)、(536.8±163.3)ml]、48 h内伤口引流量[(110.6±34.5)、(319.2±142.8)ml]、术后3 d切口疼痛程度(VAS)评分[(3.2±1.3)、(4.8±2.7)分]、术后下地活动时间[(13.6±2.0)、(15.7±2.6)d],Coffex组显著少于PLIF组(t值分别为16.720、11.380、8.771、3.320、4.018,P均<0.01);腰腿痛VAS评分、JOA评分、ODI评分、椎间高度及MSD,2组患者术后均较术前有显著改善(P均<0.01).随访12个月2组均未出现内固定松动脱出及棘突骨折等严重并发症.结论 两种术式均可有效增加椎间孔面积并维持椎间隙的高度,保留了腰椎后柱结构的稳定性,但Coflex棘突间动力内固定装置植入术更具有手术时间短、出血少、创伤小、可早期进行功能锻炼等优点.

Abstract：

Objective To explore the efficacy and safety of coflex interspinous dynamic fixation device implantation in the lumbar spinal stenosis. Methods Eighty-three patients with lumbar spinal stenosis were randomly divided into two groups, and 80 cases were followed up. Coflex group (38 patients) received coflex implantation,posterior lumbar interbody fusion (PLIF) group(42 patients) received PLIF treatment. Indicators of surgical trauma degree (operation time, blood loss volume, wound drainage volume within 48 hours, incision pain (VAS) score after surgery 3 days,postoperative ambulation time),indicators of clinical effect (waist and leg pain VAS scores,Japan Orthopaedic Association JOA score,Oswestry functional disability index ODI score),intervertebral space height and median sagittal diameter (MSO) were measured and compared between the two groups. Results In the Coflex group, the operation time, blood loss volume, wound drainage volume within 48 hours, incision pain (VAS) score after surgery 3 days,postoperative ambulation time were (104.3 ±9.5) min,(230. 7 ±29.6) ml,(110. 6 ±34. 5)ml,3. 2 ±1.3, (13. 6 ±2.0) d,which were significantly lower than those of (174. 6 ±24. 2) min,(536. 8 ±163.3) ml, (319. 2 ± 142. 8) ml,4. 8 ±2. 7, (15. 7 ±2. 6) d in the PLIF group(t= 16. 720,11. 380,8. 771,3. 320,4.018,Ps <0. 01). In the back and leg pain VAS score,JOA score,ODI score,intervertebral height and MSD,indicators after surgery were significantly improved than before surgery in both groups(Ps <0. 01). There were no significant difference before and after treatment 12 months in both groups (Ps >0. 05) on severe complications such as internal fixation loosening and spinous process fractures.Conclusion The two surgical methods both can effectively increase the foraminal area and intervertebral height to maintain the stability of the spinal posterior colum. However, Coflex interspinous dynamic fixation device implantation had more advantages,such as shorter operation time,less bleeding,less trauma,and early functional exercises.

Clinical observation of coflex interspinous dynamic internal fixation to treat degenerative lumbar spinal stenosis

Objective To explore the efficacy and safety of coflex interspinous dynamic fixation device implantation in the lumbar spinal stenosis. Methods Eighty-three patients with lumbar spinal stenosis were randomly divided into two groups, and 80 cases were followed up. Coflex group (38 patients) received coflex implantation,posterior lumbar interbody fusion (PLIF) group(42 patients) received PLIF treatment. Indicators of surgical trauma degree (operation time, blood loss volume, wound drainage volume within 48 hours, incision pain (VAS) score after surgery 3 days,postoperative ambulation time),indicators of clinical effect (waist and leg pain VAS scores,Japan Orthopaedic Association JOA score,Oswestry functional disability index ODI score),intervertebral space height and median sagittal diameter (MSO) were measured and compared between the two groups. Results In the Coflex group, the operation time, blood loss volume, wound drainage volume within 48 hours, incision pain (VAS) score after surgery 3 days,postoperative ambulation time were (104.3 ±9.5) min,(230. 7 ±29.6) ml,(110. 6 ±34. 5)ml,3. 2 ±1.3, (13. 6 ±2.0) d,which were significantly lower than those of (174. 6 ±24. 2) min,(536. 8 ±163.3) ml, (319. 2 ± 142. 8) ml,4. 8 ±2. 7, (15. 7 ±2. 6) d in the PLIF group(t= 16. 720,11. 380,8. 771,3. 320,4.018,Ps <0. 01). In the back and leg pain VAS score,JOA score,ODI score,intervertebral height and MSD,indicators after surgery were significantly improved than before surgery in both groups(Ps <0. 01). There were no significant difference before and after treatment 12 months in both groups (Ps >0. 05) on severe complications such as internal fixation loosening and spinous process fractures.Conclusion The two surgical methods both can effectively increase the foraminal area and intervertebral height to maintain the stability of the spinal posterior colum. However, Coflex interspinous dynamic fixation device implantation had more advantages,such as shorter operation time,less bleeding,less trauma,and early functional exercises.