摘要
目的:评估腰椎后路棘突间Coflex动态固定治疗腰椎管狭窄症的近期疗效。方法:对2008年3月至2009年10月连续诊治的18例行后路椎板减压、棘突间Coflex动态固定的腰椎管狭窄症患者进行回顾性分析,其中男10例,女8例;年龄54～71岁,平均62.2岁。患者临床表现包括慢性腰背痛、间歇性跛行及下肢麻木感。所有病例均为单节段中央椎管狭窄、无明显节段间不稳。其中L4,517例,L3,41例。分析术前、术后及随访时置入节段及相邻节段椎间曲度。根据VAS和ODI评分对临床疗效进行评定。结果:18例患者均获得随访,时间10～18个月,平均14.4个月。无内置物移位、断裂,影像学测量显示术后Coflex置入节段中立位Cobb角(12.1±2.6)°较术前(14.8±3.2)°明显减少(t=2.61,P=0.03),但至随访时发现置入节段中立位Cobb角(14.9±4.1)°较术后有明显增加,可接近甚至达到术前的角度(t=1.39,P=0.65)。过伸过屈位测量显示Coflex置入可较好的限制置入节段的后伸运动范围(t=4.01,P=0.001),但可观察到置入节段过屈位运动范围较术前有所增加(t=2.57,P=0.02)。相邻上一节段中立位Cobb角术前(12.1±2.3)°、术后(12.3±3.2)°、随访时(11.9±3.0)°,无统计学差异。随访时VAS评分(2.2±0.7)分较术前(4.9±1.1)分明显改善(t=2.95,P=0.02)。术前ODI评分为(56.5±14.2)%,随访时为(29.1±9.0)%,两者比较有统计学差异(t=3.02,P=0.02)。结论:从临床疗效来说,结合椎板减压Coflex置入可获得满意的疗效,但影像学测量结果显示Coflex并不能有效维持其置入后中立位下所获得的相对后凸状态,但可较好的限制置入节段的后伸活动。
Objective：To identify the initial effect of dynamic interspinous implant of Coflex on the treatment of lumbar spinal stenosis.Methods：A retrospective study of 18 patients who underwent posterior lumbar decompression and fixation with interspinous implant of Coflex between March 2008 and October 2009 was taken to compare the Cobb angel of nature and dynamic position on the segment of Coflex fixation at the time of before and after operation and following time,including 10 males and 8 females with average age of 62.2 years old（54 to 71 years）.The symptoms of patients included chronic lower back pain and intermittent claudication and lower extremity numbness.All cases including 17 cases of L4,5 and 1 case of L3,4 were central canal stenosis without obviously segmental instability.Clinical outcomes were evaluated with VAS and ODI.Results：All patients were followed up from 10 to 18 months with an average of 14.4 months.There did not about internal fixation failure.It was found that postoperative Cobb angel of fixation segment [（12.1±2.6）°] was significantly decreased than preoperative [（14.8±3.2）°]（t=2.61,P=0.03）.But the Cobb angel [（14.9±4.1）°] increased at final follow-up,even reached the level of before operation（t=1.39,P=0.65）.The Cobb angle of upper adjacent segment did not obviously change in preoperation,postoperation and final follow-up[（12.1±2.3）°,（12.3±3.2）°,（11.9±3.0）°,respectively].Dynamic measure showed that Coflex can adequately limit the ROM of extension（t=4.01,P=0.001）,but the ROM of flexion increased（t=2.57,P=0.02）.The VAS score in follow-up（2.2±0.7） was significantly decreased than before operation（4.9±1.1,t=2.95,P=0.02）.The ODI score in follow-up[（29.1±9.0）%] was significantly decreased than before operation[（56.5±14.2）%,（t=3.02,P=0.02）].Conclusion：The Coflex implanting combined with decompression can get good result clinically,but imaging showed that Coflex can not maintain the relatively kyphosis gained after operation except for extension limitation.
出处
《中国骨伤》
CAS
2011年第4期282-285,共4页
China Journal of Orthopaedics and Traumatology
关键词
椎管狭窄
减压
动态固定
脊柱非融合术
Spinal stenosis
Decompression
Dynamic fixation
Spinal non-fusion
