Coflex棘突间动态固定系统治疗腰椎间盘突出症的短期疗效评价

A short-term follow-up results of lumbar disc herniation by Coflex

目的对Coflex棘突间动态固定系统在治疗腰椎间盘突出症中的应用进行短期疗效评价。方法回顾性分析2007年11月至2008年6月采用Coflex动态固定系统治疗腰椎间盘脱出的病例31例，男性16例，女性15例；年龄33—70岁，平均年龄51．4岁。病史6—48个月，平均15．6个月。随访6个月～1年，通过VAS评分、腰椎JOA评分、Oswestry功能障碍指数（ODI）和影像学分析来评价其疗效。结果腰椎JOA评分从术前9．1±1．1增加到了26．4±1．7（术后6个月）。ODI从术前24．7±4．8降低到了4．5±1．1（术后6个月）。VAS评分从术前7．9±0．8减少到3．0±0．9（术后6个月），患者术后症状改善明显。相关影像学分析显示手术前后手术节段椎间盘背侧高度（HD）、椎间孔间最大距离（DI）、棘突顶距（DA）差异均有统计学意义（P〈0．05）。出现并发症3例，其中腰痛1例，对侧下肢痛1例，Coflex松动1例。结论Coflex在治疗腰椎间盘突出症中，确实增加了椎间盘背侧高度和椎间孔间最大距离，对维持椎间隙高度、缓解腰椎间盘突出症的根性症状具有积极的作用。

Objective To evaluate the short term effectiveness of lumbar disc herniation by Coflex. Methods From December 2007 to June 2008, 31 patients （ 16 males and 15 females） were treated by Coflex. The average age was 51.4 years （range, 33-70 years）. The average period of follow-up was 10 months. To evaluate the short term effectiveness of lumbar disc herniation by Coflex by JOA, VAS, the conventional radiography and oswestry disability index （ODI）. Results The average JOA score increased from 9. 1 ± 1.1 preoperatively to 26. 4 ± 1.7 at 6 month postoperatively. ODI decreased from 24.7 ± 4. 8 preoperatively to averaged 4. 5 ± 1.1 at 6 months postoperatively . The VAS score decreased from 7. 9 ± 0. 8 to 3.0 ± 0. 9. The clinical symptoms after operation were improved significantly. There were statistically significant differences between the preoperative and postoperative HD（ height of dorso- intervertebral discs） , DS（ distance across the two adjacent spinous processes ）, DI （distance of intervertebral foramina）. The average HD increased from （ 7.9 ± 1.1 ） mm preoperatively to （ 10. 8 ±1.3 ） mm after operation. The average DS increased from （ 28.3 ±2.4 ） mm preoperatively to （ 36. 4 ± 1.7 ） mm postoperatively. The average DI changed from （18.8±1.0）mm preoperatively to （21.6 ± 1.7） mm postoperatively. Complications occurred in 3 patients （9. 6% ）. One case complained of persistent low back pain. One case showed opposite lower limb pain in 3 weeks after operation, and was cured after appropriate treatment. One case had the loosening of Coflex in 6 months after surgery, but did not appear related clinical symptoms. Conclusion Coflex for lumbar disc herniation can increase the HD and DI significantly, and it has positive meaning for keeping height of lumbar vertebral space and treating the nerve root symptom of lumbar disc herniation.