棘突间动态内固定装置应用于腰椎间盘突出症研究

Clinical application of an interspinous device （CoflexTM） for for lumbar disc herniation

目的 比较棘突间动态固定系统（Ccoflex）与单纯腰椎间盘髓核摘除术（LD）治疗腰椎间盘突出症患者的中远期疗效.方法 收集郑州大学一附院2009年1月至2013年4月接受Coflex患者37例;接受LD患者43例.随访时间分别为（45.7±11.2）和（46.2±10.7）个月.随访期间采用日本整形外科协会（JOA）评分、视觉模拟评分（VAS）评分、Oswestry功能障碍指数（ODI）和影像学分析评估其疗效.结果 48个月内Coflex组JOA评分与VAS评分均高于单纯组（P＜0.05）,12个月内ODI评分低于单纯组（P＜0.05）;末次随访时两组椎间盘背侧高度、椎间孔最大距离和椎管面积差异均有统计学意义（P＜0.05）.结论 Coflex治疗腰椎间盘突出症临床疗效优于LD.

Objective To compare the long-term clinical effects between lumber discectomy （LD） and the Coflex interspinal dynamic fixation system in the treatment of lumbar disc herniation.Methods From January 2009 to May 2013,80 cases of lumbar disc herniation were enrolled in our study,including 37 cases subject to lumber discectomy,and 43 cases subject to Coflex system.All patients received visual analogue scale （VAS）,lumbar Japanese Orthopaedic Association （JOA） score and the Owestry disability index （ODI） assessment before and 12,24,36 and 48 months after operation.Surgically resected segmental dorsal disc height,the ventral disc height and spinal canal area were also measured through X-ray film and CT.Results The scores of JOA and VAS were significantly higher in Coflex group than in LD group 48 months after surgery （P ＜ 0.05）.Coflex system treatment also showed advances in ODI assessment during the follow-up period of 12 months （P ＜ 0.05）.There was significant difference in the surgically resected segmental dorsal disc height,the ventral disc height and spinal canal area between preoperation and the last follow-up,and there was also significant difference in the above parameters between the two groups at the last follow-up （P ＜ 0.05）.Conclusion Forty-eight-month follow-up showed that patients subject to Coflex system had advantages in long-term clinical efficacy over LD.