腰椎Coflex棘突间动态稳定术后再手术原因分析

The reoperation of Coflex dynamic interspinous stabilization system in the treatment of lumbar degenerative disease

目的：评价腰椎退变性疾病应用Coflex棘突间动态稳定术治疗的再手术发生情况，探讨其原因及治疗方法。方法：2007年9月～2015年7月，295例腰椎退变性疾病患者在我院接受减压及Coflex棘突间动态稳定手术。采用回顾性分析方法，统计本组患者术后再手术的发生情况，探讨其再手术原因和处理方法，并对所有再手术患者进行随访，根据患者主观满意度评价再手术效果。结果：295例患者中．再次手术患者共16例，再手术率为5．4％。所有再手术患者二次手术时间距离首次手术15．1±23．4个月（0．1-60个月）。16例再手术患者中，非内固定相关并发症者6例（37．5％），其中切口感染2例、伤口深层血肿形成4例，均采取感染清创或血肿清除（1例因行棘突切除取出Coflex）治疗后痊愈；内固定相关并发症者10例（62．5％），其中2例Topping—off术后患者再手术原因为融合节段内固定松动或神经根粘连，更换内固定及神经根松解后症状缓解：另8例单节段Coflex置入患者主要原因为原手术节段或邻近节段退变，接受再次探查减压、融合后症状缓解，其中1例为新发节段症状，予以减压融合后症状缓解。本组所有再手术患者中，无1例因Coflex内固定直接相关并发症（内固定移位、松动、脱出或棘突骨折）再次手术。所有再手术患者术后随访时间28．6±12．6个月（6～48个月），末次随访时患者主观满意度总体优良率为93.8％。结论：Coflex棘突间动态稳定术治疗腰椎退变性疾病再手术原因与Coflex装置无直接相关，主要影响因素与切口感染、深层血肿及原手术或邻近节段退变有关。

Objectives： To evaluate the rate of revision surgery after posterior Coflex interspinous dynamic stabilization for lumbar spine degenerative disorders, and to discuss its causes and management. Methods： From September 2007 to July 2015, 295 patients with the degenerative disorders of lumbar spine were treated with decompression and Coflex interspinous dynamic stabilization in our hospital. In order to evaluate the rate of revision surgery among these patients and discuss its causes and management, a retrospective study was conducted and all patients were surgically treated and followed up to evaluate the clinical outcome based on patient satisfaction. Results： Among 295 patients in this study, there were 16 patients undergoing revision surgery and the total rate of reoperation was 5.4%. The duration between revision procedure and primary procedure was 15.1±23.4 months（range, 0.1-60 months） in these patients. Among the 16 patients, 6 patients （37.5%） had non-implant related complications including the infection of wound or local hemotoma. All these 6 patients healed after debridement or hematoma removal. Another 10 patients（62.5%） underwent reoperation due to implant related complications. There were two patients who had topping-off procedure initially devel- oped pedicle screw loosening or nerve root adhesion and were treated with the reimplantation of fixation. An- other 8 patients who had single level Coflex dynamic stabilization developed symptoms of deterioration of pre- vious segment or adjacent segment. Those patients were managed with decompression and fusion with pediele screw fixation. None of the 16 patients had the Coflex related problem such as the migration, loosening or the spinous process. These patients were followed up for28.6±12.6 months（range, 6-48 months） and 93.8% of the patients were satisfied with the revision surgery at the final follow-up. Conclusions： Coflex interspinous dynamic stabilization for the treatment of degenerative disorders of the lumbar spine is safe and the reoperation rate is low. The main cause of revision surgery in- cluding wound infection, loeal hemotoma, degeneration at previous segment or adjacent segment is not direetly related to Coflex implant itself.