摘要
目的:评价采用Coflex棘突间动力内固定装置治疗退行性腰椎管狭窄的疗效及其影像学变化。方法:2007年10月至2009年2月对诊断为退行性腰椎管狭窄的30例行Coflex棘突间动力内固定治疗。其中男17例,女13例;年龄39～65岁,平均45岁。手术在L4,5节段20例,L5S1节段9例,1例同时行L4,5、L5S1双节段治疗。所有患者手术前后均行Oswestry功能障碍指数评分(ODI)和日本骨科学会评分(JOA)。影像学观察指标包括X线中立位椎间隙腹、背侧高度,动力位手术节段上下两椎体的边缘与其相邻椎体的边缘连线的夹角变化;CT测量指标包括椎管面积、硬膜囊面积、椎管矢状径、硬膜囊横矢状径。手术采用椎板开窗或部分切除,椎管减压后棘突间植入Coflex装置。结果:随访5～19个月,ODI分值由术前的平均(62.41±10.38)分下降到平均(10.49±5.93)分(P<0.01),JOA分值由术前的平均(8.96±2.76)分提高到平均(25.36±1.55)分(P<0.01)。3例术后疼痛改善不明显而需药物或封闭治疗,3例麻痹及感觉减退症状无改善,其余患者症状均获明显改善,未再出现间歇性跛行及神经根压迫症状。未发现与Colfex装置本身相关的并发症。X线检查椎间隙背侧高度明显增大,手术节段相邻椎体间运动幅度无明显增大。CT检查术后椎管内空间,硬膜囊面积均有所增加。结论:采用Coflex棘突间动力内固定治疗退行性腰椎管狭窄,短期相关并发症少,同时对增加椎管及硬膜囊面积,增加椎间隙后缘高度,防止相邻节段运动幅度增加以及预防邻椎病发生具有积极的作用。
Objective：To assess the clinical outcomes of Coflex interspinous dynamic internal fixation and the imaging changes for degenerative lumbar spinal stenosis.Methods：From October 2007 to February 2009,30 patients with degenerative lumbar spinal stenosis were treated with Coflex interspinous dynamic internal fixation,including 17 males and 13 females with an average age of 45 years （range,39 to 65 years）.The operation level at L4,5 were 20 cases,L5S1 9 cases and 1 case was in both the two levels.The ODI scores and JOA questionnaires were assessed before and after operation.The radiological measurement included ventral and dorsal intervertebral space height,segmental intervertebral angles formed by lines drawn on the upper and lower endplates of the instrumented and adjacent levels on flexion extension radiographs;the area of spinal canal,dural sac,the sagittal and transverse diameter of the spinal canal and dural sac on CT scan.All the patients were treated with limited laminectomy and were implanted with Coflex device.Results：All the patients were followed up for 5 to 19 months.There were significant differences in the ODI scores and the JOA questionnaires by paired t test （P〈0.01）.All the patients were satisfied with surgical outcomes except 3 patients whose pain were not obviously relieved and need drugs or block therapy;3 patient complaining of progressive hypoesthesia.There were no complications associated with the Coflex device.The height of dorso intervertebral disc was increased obviously while the range of motion in adjacent levels was not increased on flexion extension radiographs;the area of spinal canal and dural sac were significantly increased.Conclusion：It shows a good clinical result to release the degenerative lumbar spinal stenosis symptoms and decrease short term complications by using Coflex device.It is available for patients with increasing the intervertebral space,area of spinal canal and preventing the adjacent segment degeneration.
出处
《中国骨伤》
CAS
2009年第12期902-905,共4页
China Journal of Orthopaedics and Traumatology
关键词
椎管狭窄
腰椎
内固定器
骨科手术方法
减压术
外科
Spinal stenosis
Lumbar vertebrae
Internal fixators
Orthopaedics operative methods
Decompression
surgical
