Coflex植入术治疗退行性腰椎管狭窄症41例的临床观察

Clinical observations of Coflex implant on the treatment of 41 cases of degenerative lumber spinal stenosis

目的探讨腰椎后路棘突间Coflex植入术治疗退行性腰椎管狭窄症(DLSS)的临床疗效。方法 2012年2月至2013年9月期间收治的74例DLSS患者,按愿意分为对照组33例和治疗组41例,其中对照组接受全椎板减压植骨融合内固定术,治疗组接受Coflex植入术。比较两组手术时间、出血量、并发症;日本整形外科学会(JOA)下腰痛评分、疼痛视觉模拟标尺(VAS)评分、美国脊柱损伤协会(ASIA)神经功能分级;X线片测定植入节段椎间隙前后缘的高度、椎弓根间距及Cobb角。结果治疗组与对照组相比,手术时间缩短[(1.02±0.32)h vs(2.13±0.58)h]、术中出血量减少[(145.5±36.0)mL vs(279.3±56.8)mL]、并发症减少(0 vs 9.1%)(P<0.05);两组JOA下腰痛评分均较术前明显增高,VAS评分较术前明显降低(P<0.05),治疗组术后VAS评分较对照组更低[(2.3±0.3)vs(2.6±0.6),P<0.05];术后两组神经功能均有一定程度恢复,但组间比较差异无统计学意义(P>0.05);两组患者手术前后植入节段椎间隙前缘高度、椎弓根间距及Cobb角均无明显变化,椎间隙后缘高度均增大[治疗组术前与术后比较[(7.31±1.36)mm vs(8.98±1.56)mm],对照组术前与术后比较[(7.19±1.08)mm vs(8.61±1.41)mm,P均<0.05],但组间比较差异无统计学意义。结论腰椎后路棘突间Coflex植入术是一种治疗退行性腰椎管狭窄症安全、有效的手术方法。

Objective To observe the clinical effects of Coflex implant on the treatment of degenerative lumber spinal stenosis（ DLSS）. Methods Seventy-four patients in department of orthopaedics,Huaxin Hospital from 2012 February to 2013 September with DLSS were divided into control group（ 33 cases） and study group（ 41 cases）. The control group received laminectomy and posterior interbody fusion along with pedicle screw system; the study group received Coflex implant. The operation time,intraoperative blood loss,complication incidence,JOA score,VAS score and ASIA rate were compared between the two groups. Results Compared with the control group,the operation time[（ 1. 02 ±0. 32） h vs.（ 2. 13 ± 0. 58） h],the intraoperative blood loss[（ 145. 5 ± 36. 0） mL vs.（ 279. 3 ± 56. 8） mL]and complication incidence（ 0 vs. 9. 1%） were less in the study group（ all P〈0. 05）. The JOA low back pain score postoperation were increased than pre-operation,the VAS score were decreased（ all P〈0. 05）.The VAS score in the study group were lower than in the control group（ 2. 3 ± 0. 3 vs. 2. 6 ± 0. 6,P〈0. 05）.After operation,the certain recovery of neurological function had been observed,but had no significant difference between the two groups. In both groups,the height of interveterbral space at anterior border,the space length between the two vertebral pedicles and Cobb＇s of implant segment had no significant difference before and after operation,the height of interveterbral space at posterior border were increased after operation [study group：（ 7. 31 ± 1. 36） mm vs（ 8. 98 ± 1. 56） mm,control group ：（ 7. 19 ± 1. 08） mm vs（ 8.61 ±1. 41） mm,both P〈0.05],but there was no significant difference between the two groups.Conclusion Coflex implant is safe and effective for the surgical treatment of DLSS.