Coflex植入术与Quadrant通道下TLIF结合经皮Sextant椎弓根螺钉治疗退行性腰椎管狭窄症的疗效对比

Comparison of Short Term Outcome in the Treatment of Degenerative Lumbar Stenosis between Coflex Interspinous Implant and TLIF via MAST Quadrant Retractor Combine with Mini-invasive Percutaneous Pedicle Screw Fixation Sextant System

目的:对比棘突间动态稳定装置Coflex系统植入与Quadrant通道结合经皮Sextant椎弓根螺钉内固定术治疗退行性腰椎管狭窄症的短期疗效。方法:抽取兰州军区兰州总医院骨科中心脊柱外科及第四军医大学唐都骨科医院脊柱外科的30例住院治疗退行性腰椎管狭窄症的患者,随机化分为2组,每组15例,分别行Coflex系统植入和Quadrant通道结合经皮Sextant椎弓根螺钉内固定术,观察比较两组的手术时间、出血量、术后住院时间、术前和术后6个月Oswestry功能障碍指数(Oswestry disability index,简称ODI)及视觉模拟评分法(Visual Analogue Scale/Score,简称VAS)。结果:两组术前、术后6个月ODI及VAS评分对比差异有统计学意义,而在手术时间、术中出血量及术后住院天数方面Coflex组优于Quadrant+Sextant组,两组在术后6个月ODI评分方面差异无统计学意义,在术后6个月VAS评分方面Quadrant+Sextant组优于Coflex组,随访期间两组无并发症发生。结论:Coflex植入术及Quadrant通道结合经皮Sextant椎弓根螺钉内固定术均为治疗退行性腰椎管狭窄症的有效手段,但其各有特点,在临床工作中,应当严格掌握手术适应症,选择适当的手术方案,从而在最小的创伤和侵扰的同时获得最佳的疗效。

Objective： To compare the short term outcome in treatment of degenerative lumbar stenosis between Coflex interspinous implant and TLIF via MAST Quadrant retractor combine with mini-invasive percutaneous pedicle screw fixation Sextant system. Methods： Thirty patients from the Department of Spine Surgery, Lanzhou General Hospital of Lanzhou Military Command, PLA and Department of Orthopaedics, Tangdu Hospital of Fourth Military Medical University, PLA with degenerative lumbar stenosis were randomly divided into two groups. Fifteen patients in one group were treated by TLIF via MAST Quadrant retractor combine with Sextant system. The other 15 patients were treated by Coflex interspinous implant. The parameter for assessment include operation time, intraoperative blood loss, hospital stay days, per- and postoperative ODI and VAS scores. Results： There were significant differences between per- and postoperative ODI and scores. Compared to the Quadrant＋Sextant group, significant different was found in operation time, intraoperative blood loss, hospital stay days and postoperative VAS score, while no significant differences were found in postoperative ODI score. In addition, there were no complications during follow-up time. Conclusion： Both Coflex interspinous implant and TL1F via MAST Quadrant retractor combined with Sextant system are effective methods for the treatment of degenerative lumbar stenosis, and each of them has its incaditions.In clinical work,we should select suitable method to obtain the most satisfying effect with minimal wound or damage.