Coflex棘突间动态稳定结合腰椎减压融合术治疗腰椎间盘退行性疾病的中期疗效

Mid-term effectiveness of Coflex interspinous dynamic internal fixation combined with spinal fusion for lumbar disc degeneration

目的探讨Coflex棘突间动态稳定结合腰椎减压融合术治疗腰椎间盘退行性疾病的疗效。方法回顾分析2010年6月—2011年12月符合选择标准的39例腰椎间盘退行性疾病患者临床资料,根据手术方式不同分为A组(20例,单纯腰椎减压融合)和B组(19例,Coflex棘突间动态稳定结合腰椎减压融合)。两组患者年龄、性别构成、疾病诊断构成、病变节段、病程以及术前Oswestry功能障碍指数(ODI)、疼痛视觉模拟评分(VAS)、上位手术节段及其邻近非融合节段椎间隙高度、椎间孔高度(foramen intervertebral height,FIH)、腰椎活动度(range of motion,ROM)等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。术前及末次随访时采用ODI和VAS评分评估临床疗效,计算改善率;测量并比较两组上位手术节段及其邻近非融合节段椎间隙高度[前缘高度(anterior disc height,ADH)、中部高度(middle disc height,MDH)和后缘高度(posterior disc height,PDH)]、FIH、腰椎ROM。结果 A组手术时间和术中出血量显著多于B组(P<0.05),两组住院时间比较差异无统计学意义(t=0.992,P=0.328)。两组均获随访,A组随访时间33~50个月,平均40.5个月;B组39~51个月,平均42.6个月。两组均未发现内固定物移位、松动或断裂等并发症。两组末次随访时ODI、VAS评分均较术前显著改善(P<0.05);末次随访时,两组ODI、VAS评分以及ODI改善率比较差异均无统计学意义(P>0.05),B组VAS评分改善率明显优于A组(t=2.245,P=0.031)。末次随访时两组间及组内手术前后上位手术节段椎间隙高度及FIH比较,差异均无统计学意义(P>0.05)。末次随访时,B组邻近非融合节段ADH显著高于A组,MDH、PDH和FIH显著低于A组(P<0.05);与术前比较,末次随访时A组邻近非融合节段ADH降低,MDH、PDH和FIH增高(P<0.05),而B组各指标均无明显改变(P>0.05)。末次随访时,A组邻近非融合节段ROM较术前显著增加(t=2.318,P=0.026);两组邻近非融合节段ROM比较差异有统计学意义(P<0.05)。结论对于腰椎间盘退行性疾病,Coflex棘突间动态稳定结合减压融合术中期疗效与单纯减压融合术相当。对于责任节段的邻近节段存在退变、但暂无症状或症状轻微患者,采用该术式可以减缓邻近节段退变。

Objective To evaluate the effectiveness of Coflex interspinous dynamic internal fixation combined with spinal fusion for lumbar disc degeneration. Methods The clinical data of 39 patients with two-level lumbar disc degeneration who met the selection criteria between June 2010 and December 2011 was retrospectively analyzed. They were divided into group A(20 cases, simple lumbar decompression and fusion) and group B(19 cases, Coflex interspinous dynamic internal fixation combined with spinal fusion) according to different surgical methods. There was no significant difference in age, gender, disease diagnosis, lesion segment, disease duration, Oswestry disability index(ODI), visual analogue scale(VAS) score, and the intervertebral height, foramen intervertebral height(FIH), and range of motion(ROM) of upper operative segment and adjacent segment between the two groups(P>0.05). ODI and VAS score were used to evaluate the effectiveness before operation and at last follow-up, and the improvement rates were calculated. The intervertebral height [anterior disc height(ADH), middle disc height(MDH), and posterior disc height(PDH)], FIH, and ROM were measured and compared between the two groups. Results The operation time and intraoperative blood loss in group A were significantly more than those in group B(P<0.05), and there was no significant difference in hospitalization time between the two groups(t=0.992, P=0.328). All patients were followed up;the follow-up time was 33-50 months(mean, 40.5 months) in group A and 39-51 months(mean, 42.6 months) in group B. No complication such as displacement, loosening, or rupture of internal fixator was found in both groups. At last follow-up, ODI and VAS score of the two groups significantly improved when compared with preoperative scores(P<0.05). At last follow-up, there was no significant difference in ODI, VAS score, and improvement rate of ODI between the two groups(P>0.05);the improvement rate of VAS score in group B was significantly higher than that in group A(t=2.245, P=0.031). There was no significant difference in the intervertebral height and FIH of the upper operative segment at last follow-up between the two groups and between preoperation and last follow-up in the two groups(P>0.05). At last follow-up, the ADH of adjacent segment in group B was significantly higher than that in group A, and MDH, PDH, and FIH were significantly lower than those in group A(P<0.05). Compared with preoperation, the ADH of adjacent segment in group A decreased and MDH, PDH, and FIH increased at last follow-up(P<0.05), while all indexes in group B did not change significantly(P>0.05). The ROM of adjacent segment in group A increased significantly at last follow-up(t=2.318, P=0.026). There was significant difference in ROM of adjacent segment between the two groups(P<0.05). Conclusion The mid-term effectiveness of Coflex interspinous dynamic internal fixation combined with spinal fusion is similar to that of simple decompression fusion. For those patients whose adjacent segments of the responsible segments have degeneration but have no symptoms or mild symptoms, this treatment can slow down the adjacent segment degeneration.