Coflex棘突间动力重建系统治疗腰椎退变性疾病18例

背景：近年来脊柱非融合技术一直是脊柱外科研究与争论的热点。Coflex棘突间动力重建系统作为腰椎后路非融合器材,国外虽已应用较长时间,但国内尚处于试用阶段。目的：探讨Coflex棘突间动力重建系统治疗腰椎退变性疾病的适应证,并对其早期临床疗效进行评价。方法：2008-10/2010-06使用Coflex棘突间动力重建系统治疗腰椎退变性疾病31例,对其中随访超过1年的18例患者临床资料进行分析总结。治疗方式均为后路髓核摘除,椎管减压、Coflex棘突间动力重建系统置入;1例患者术中置入2枚Coflex。治疗前及各次随访时均对患者进行日本骨科学会下腰痛功能量表、中文版Oswestry功能障碍指数量表及目测类比评分法评估,并测量治疗前后、各次随访时腰椎前屈后伸位置入节段及其上下节段活动范围、Colfex上下极板夹角及置入节段椎间隙高度。结果与结论：患者均获随访,随访时间12～20个月。末次随访时患者日本骨科学会下腰痛功能量表评分、中文版Oswestry功能障碍指数量表评分及目测类比评分均获显著改善;治疗前后置入节段椎间高度及其上下节段椎间活动度差异均无显著性意义（P〉0.05）,末次随访时Coflex上下极板夹角在过伸位较中立位显著增大（P〈0.05）。提示Coflex棘突间动力重建系统对腰椎间盘突出症、椎管狭窄及腰椎不稳等腰椎退变性疾病安全有效,在腰椎后伸时能够有效分担载荷,同时对腰椎生理活动影响较小,有利于维护腰椎功能,早期临床疗效肯定。

Coflex interspinous process dynamic reconstruction system for treatment of lumbar degenerative diseases in 18 cases

BACKGROUND：In recent years,the technique of the spinal nonfusion is the focus for researching and debating in the filed of spinal surgery.Coflex interspinous process dynamic reconstruction system is a posterior nonfusion equipment,despite of used for a long time abroad,but in China is still in a trail stage.OBJECTIVE：To explore the indications of Coflex interspinous process dynamic reconstruction system in the treatment of lumbar degenerative diseases and its early clinical efficacy.METHODS：From October 2008 to September 2010,31 patients with lumbar degenerative diseases were treated by Coflex interspinous process dynamic reconstruction system,of which 18 cases were followed up more than 1 year,and we analyzed and summarized their clinical data.Surgical procedures were posterior resection of nucleus pulposus,decompression of spinal canal and implantation Coflex interspinous dynamic reconstruction system,only 1 patient was implanted 2 Coflexes in surgery.The patients＇ JOA,VAS,and ODI scores,the intervertebral height of the implanted segment and the range of motion （ROM） of adjacent segments,and the angle of the upper and lower plates of the Coflex in each position were evaluated before and after the operation,and at every follow-up.RESULTS AND CONCLUSION：All cases were followed up for 15.4 （12-20） months.The patients＇ JOA,VAS,ODI scores have been significantly improved at the last follow-up.The intervertebral height of the implanted segment and the ROM of adjacent segments had no significant change （P0.05）,the angle of the upper and lower plates of the Coflex in the hyperextension position is significantly increased than in the neutral position at the last follow-up （P0.05）.Coflex interspinous process dynamic reconstruction system is a safe and effective technique for treatment lumbar degenerative diseases,such as lumbar disc herniation,spinal stenosis and lumbar instability,and it not only have little impact on physical function of lumbar but also effectively share the load when the lumbar spine extend backward,so its early clinical efficacy is positive.