Coflex棘突间动力内固定装置治疗退变性腰椎管狭窄症短期疗效分析

The short-term clinical efficacy of the internal fixation system Coflex′s treatment on degenerative lumbar spinal stenosis

目的：评价Coflex棘突间动力内固定装置治疗退变性腰椎管狭窄症的短期临床疗效。方法选择2008年10月-2012年10月新疆医科大学第一附属医院创伤科收住的退变性腰椎管狭窄症患者20例，将Coflex棘突间动力内固定装置植于L3∽4棘突间或L4∽5棘突间单节段或连续L3∽4、L4∽5棘突间节段。所有患者均随访3∽24个月，平均随访时间12个月。采用日本骨科学会腰背痛手术评分标准（JOA）、Oswestry功能障碍指数评分（ODI）和疼痛视觉评分（VAS）评估患者术后功能障碍恢复情况及疼痛缓解情况。观察20例患者住院时间、术后恢复住院观察时间、手术时间、术中失血量及临床疗效。结果（1）住院时间平均9 d ，术后恢复住院观察时间平均3∽5 d ，手术时间平均82 m in ，术中失血量平均100 m L。全部病例下腰痛明显缓解；3例（15％）术前绝对不能下床自主活动者术后2例（10％）可下床活动，患侧下肢放射性疼痛、臀部感觉异常、腰部活动受限、腰部后伸障碍、小腿外侧或足背外侧感觉减退情况均较术前有明显缓解。（2）JO A 评分由术前的（8．55±2．33）分增至术后的（264．0±16．4）分，ODI由术前的（838．8±46．7）％减至术后的（466．5±45．8）％，VAS评分由术前的（80．5±10．0）分减至术后的（37．5±09．1）分，术后JOA、VAS及ODI评分与术前相比差异均有统计学意义（P ＜0.05）。（3）20例患者住院期间未发现感染、棘突周围骨折、植入物脱落或断裂等严重相关并发症；1例患者术中硬脊膜撕裂出现脑脊液漏，术中放置术区引流，切口严密缝合，延迟拔管后痊愈。结论 Coflex棘突间动力内固定装置治疗退变性腰椎管狭窄症短期临床疗效较为满意，但长期疗效尚需进一步观察。

Objective To evaluate the interspinous dynamic fixture Coflex′s short-term clinical efficacy on degenerative lumbar spinal stenosis .Methods Coflex was used in retrospective analysis of treatment of 20 patients （11 males and 9 females ,aged 42 to 73 years ,mean 61 years old） with degenerative lumbar spinal stenosis at the department of traumatology in the First Affiliated Hospital of Xinjiang Medical University from October 2008 to October 2010 .Coflex devices were used at L3-4 spinous process or L4-5 spinous＆amp;nbsp;process or continuous L3-4 ,L4-5 spinous process between the two segments in the 20 cases of patients with degenerative lumbar spinal stenosis .All patients were followed up for 3 to 24 months ,with an aver-age follow-up time of 12 months .All patients were evaluated to observe postoperative function obstacle re-covery and pain relief by the Japanese Orthopaedic Association low back pain scoring procedure （Japanese Orthopedic Association ,JOA） ,Oswestry Disability Index score function （ODI） and Visual Analogue Scale （VAS） before surgery and postoperation .Results Coflex fixation system was used to treat the pa-tient with degenerative lumbar spinal stenosis .Postoperative lumbocrural pain recovered well and the obvi-ous postoperative complications were not seen .JOA score （8 5.5 ± 2 3.28） before surgery increased to posto-peration（26 .40 ± 1 .635） points ,ODI score （83 .88 ± 4 .673）% before surgery reduced to postoperation （46 6.5 ± 4 5.82）% points and VAS score （8 .05 ± 0 .999） before surgery reduced to postoperation （3 .75 ± 0 9.10） points .During follow-up ,JOA ,VAS and ODI scores between postoperation and preoperation have statistically significant difference （P 〈 0 .01） .Conclusion The short-term clinical efficacy of Coflex fixation system w hich aims to treat degenerative lumbar spinal stenosis is satisfying ,but long-term effects need further observation .