Coflex固定治疗L_(4～5)椎管狭窄及不稳的近期临床疗效分析

Function evaluation after interspinous implantation with Coflex after surgical decompression in degenerative lumbar stenosis with segmental instability with one year following-up

目的探讨腰椎棘突间Coflex固定治疗L4～5单节段腰椎管狭窄症伴轻度不稳的疗效。方法该院于2007年3月至2008年2月采用Coflex固定收治了18例L4～5腰椎管狭窄症伴轻度不稳患者,行椎管减压或加髓核摘除术后行Coflex固定。术后3、12个月随访时行腰椎正侧位、屈伸动力位X线检查,测量L4～5及L3～4节段活动度、L4～5椎间隙后缘高度,选用JOA和VAS评分评价手术效果。结果手术时间(72±14.6)min;出血量(56±25.4)mL;VAS评分和JOA评分术前与术后VAS、JOA评分差异有统计学意义(P<0.05)。术前、术后3、12个月随访L4～5节段活动度(ROM)、L4～5椎间隙后缘高度(PDH)显示术前与术后差异有统计学意义(P<0.05)。L3～4活动度各时间段差异无统计学意义(P>0.05)。结论Coflex固定治疗L4～5椎管狭窄症伴轻度不稳,短期疗效良好,在稳定病变节段同时能减轻相邻运动节段应力防止其继发退变。

Objective To report the outcome,radiologic findings in the patients having spinal stenosis with mild segmental instability and undergoing surgical radieular decompression and implantation of Coflex in . Methods Eighteen adult patients having degenerative spinal stenosis with mild segmenlal instability and underwent implantation of Coflex （Spine motion, Germany） after lumbar mierosurgical decompression at L4-5 level were consecutively selected and studied for one-year clinical outcome. The clinical evaluation included visual analogue scale （leg and hack）,JOA scale,and radiologic assessment preoperative and postoperative at 3 and 12 months. Results Average operation time was （72±14. 6）min,blood Lose during operation was （56±25.4）Ml,.In 3 and 12 months after surgery, the visual analogue scale score （VAS） and JOA score for both lower extremity pain and low back pain showed a significant improvement. The postoperative range of movement fROM） at L4-5 level decreased significantly compared with the preoperative ROM. The posterior disc height （PDH） of L4-5 showed a significant change. The R（）M at the upper adjacent segments （L2-4） was not changed apparently during the follow up. Conclusion The placement of the interspinous Coflex shows an excellent and good clinical outcome in the patients having spinal stenosis with mild segmental instability in L4-5 and this method does not significantly affect degeneration at the adjacent segments.