棘突间动态稳定装置Coflex治疗退行性腰椎疾病的临床疗效分析

Clinical efficacy analysis of coflex interspinous stabilization in the treatment of degenerative lumbar disease

目的探讨棘突间动态稳定装置Coflex治疗退行性腰椎疾病的临床疗效。方法回顾性研究我院2009年1月至2013年12月采用Coflex治疗的173例退行性腰椎疾病患者。单纯Coflex治疗104例,男47例,女57例;年龄27～84岁,平均57.8岁;Topping-off治疗69例,男37例,女32例,年龄39～78岁,平均59.4岁。记录手术时间、术中出血量及术后并发症。选用Oswestry功能障碍指数（oswestry disability index,ODI）、视觉模拟评分（visual analogues-cale,VAS）评价临床疗效。拍摄腰椎站立位的正侧位X片,测量并记录Coflex节段的术前、术后3个月、术后1年、终末随访时的椎间角度和椎体后缘高度。结果本组随访12～64个月,平均（28.1±12.2）个月。单纯Coflex的平均手术时间（92.2±24.6）min,平均出血量（195.5±62.2）ml;Topping-off的平均手术时间（173.7±28.7）min,平均出血量（415.5±80.7）ml。单纯Coflex术后伤口感染2例,术后5年翻修1例;Topping-off术后伤口感染2例,椎管内血肿2例,术后3年Coflex置入节段翻修1例,术后3年融合节段下位椎间盘突出行二次手术1例。术后1年随访的腰痛及腿痛VAS评分、ODI评分与术前比较,差异有统计学意义（P〈0.05）。Coflex置入节段术后3个月椎间角度均小于术前,差异均有统计学意义（P〈0.05）,术后1年、终末椎间角度与术前比较差异均无统计学意义（P〉0.05）;术后3个月椎体后缘高度均大于术前,差异有统计学意义（P〈0.05）,术后1年、终末椎体后缘高度与术前比较差异无统计学意义（P〉0.05）。结论棘突间动态稳定装置Coflex治疗退行性腰椎疾病的中短期随访临床疗效满意,Coflex节段的椎间角度及椎体后缘高度术后短期内可获得明显的改善。

Objective To discuss the clinical results of Coflex interspinous stabilization for the treatment of degenerative lumbar disease. Methods From January 2009 to December 2013, 173 patients with degenerative lumbar disease receiving Coflex implantation were retrospectively investigated. Coflex treatment were performed in 104 cases,including47 males and 57 females,the mean age was 57.8 years old（27-84 years）. Topping-off operation was performed in 69 cases, including 37 males and 32 females, the mean age was 59.4 years old（39-78 years）. The operation time,intraoperative blood loss and postoperative complications were recorded. Oswestry disability index（ODI） and visual analogue scale（VAS）were used to evaluate the clinical results. The inter-vertebral angle and the posterior vertebral body-height in the Coflex implant segments were measured and recorded by the Anterior-posterior and lateral X-ray radiograph during before operation, 3 months and 1 years after operation, and final follow-up. Results All patients were followed-up with an average of 28.1 ± 12.2months（12- 64 months）. The average time was 92.2 ± 24.6min and the average blood loss was 195.5 ±62.2ml in Coflex surgery. The average operation time was 173.7±28.7min and the average blood loss was 415.5±80.7ml in Topping-off surgery. After Coflex surgery,incision infection happened in 2 cases,revision occurred after five years in 1cases. After Topping-off operation, incision infection happened in 2 cases, intraspinal hematoma were discovered in 2 cases, revision occurred after three years in 2 cases respectively owing to recurrence in Coflex implant segmentand intervertebral disc herniation underfusion segment. Preoperative VAS, ODI scores were statistically different 1 year after the operation（P〈0.05）. In Coflex implant segments, intervertebral angle of 3 months after operation was less than the angle of after operation and the differences were statistically significant（P〈0.05）. Comparing the preoperative angle, there were no significant difference could be found between 1 year or final follow-up after surgery（P〈0.05）. Posterior vertebral bodyheight 3 months after operation was more than that of before the operation and the differences were statistically significant（P〈0.05）. there were no significant difference in the preoperative height, 1 years and final follow-up after surgery（P〈0.05）. Conclusion Coflex interspinous stabilization in the treatment of degenerative lumbar disease could obtain satisfied clinical results in the short-medium term followed-up. In Coflex implanted segments, the intervertebral angle and the posterior vertebral body-height show significant improvement in the short term after surgery.