摘要
目的通过与传统腰椎后路椎间融合术对比来观察腰椎棘突间置入Coflex系统治疗腰椎退行性疾病的近期疗效。方法收集2014年3月至2016年3月新疆生产建设兵团医院因腰椎退行性疾病住院行手术治疗的病人50例,采用随机数字表法分为观察组和对照组,观察组23例采用Coflex非融合手术治疗,对照组27例采用腰椎后路椎间融合TLIF手术治疗。收集两组手术时间、术中出血量及住院时间,统计两组术前、术后1、6、12、24个月的腰椎功能障碍指数(ODI)、疼痛视觉模拟评分(VAS)及日本骨科协会治疗评估分数(JOA)评分,及复查腰椎四位X线片(正位、侧位、过伸位、过屈位)测量手术节段及其邻近上一节段腰椎主动活动范围(ROM),分析两组手术的术后疗效。结果观察组手术时间(89.5±8.1)min,术中出血量(287.8±11.0)mL,住院天数(8.1±1.5)d;对照组手术时间(117.6±13.4)min,术中出血量(381.7±14.2)mL,住院天数(12.5±1.9)d,观察组均明显优于对照组,差异有统计学意义(P<0.01)。在术后疗效果上,两组ODI比较,观察组术前评分为(26.4±5.8)分,末次随访中评分为(3.9±1.2)分;对照组术前评分为(27.0±4.6)分,末次随访中评分为(4.0±1.3)分,差异无统计学意义(t=-0.350,P=0.728);两组JOA比较,观察组术前评分为(9.0±3.6)分,末次随访中评分为(27.1±3.3)分;对照组术前评分为(9.3±2.8)分,末次随访中评分为(27.2±2.7)分,差异无统计学意义(t=0.030,P=0.976);两组VAS比较,观察组术前评分为(7.9±1.4)分,末次随访中评分为(2.9±0.9)分;对照组术前评分为(7.9±0.7)分,末次随访中评分为(2.9±1.1)分,差异无统计学意义(t=0.205,P=0.839);在腰椎主动活动范围上,观察组术前与末次随访的手术节段ROM差异无统计学意义(t=1.585,P=0.120),手术上一节段的ROM差异无统计学意义(t=-1.546,P=0.129);而对照组术前与术后末次随访的手术节段ROM差异有统计学意义(t=13.503,P<0.01),手术上一节段的ROM差异有统计学意义(t=-5.761,P<0.01)。结论腰椎棘突间置入Coflex系统在治疗腰椎退行性疾病可取得与TLIF同样的疗效,并且具有手术时间短、术中出血量低及住院时间较短的优势,具有较好的安全性,同时相对于TLIF在保存相关腰椎主动活动范围上有较好的表现。
Objective To observe the short?term efficacy of Coflex interspinous dynamic internal fixationin the treatment of lumbar degenerative disorders by comparison with traditional lumbar posterior lumbar interbody fusion.Methods 50 patientswith lumbar disc diseaseenrolled in Xinjiang Production and Construction Bingtuan Hospital from Mar 2014 to Mar 2016 were separatedto 2 groups by Digital Table Method:twenty patientsin observation group with degenerative lumbar degeneration were treated with coflex non?fusion surgery,thirty patients in control group were treated with posterior lumbar interbody fusion TLIF.The operative time,in?traoperative blood loss and length of stay in both groups were collected.Japanese Orthopedic Association(JOA)scores,visual ana?logue scale(VAS)scores,Oswestry disability index(ODI)scores were compared between the 2 groupspreoperative andpostopera?tive 1,6,12,24 months.Four sections of lumbar spine(orthophorus,lateral position,hyperextension position,flexion position)were reviewed to measure ROM of the lumbar spine motion range of the operative segment and its adjacent segment,by whichthe effica?cy of the two operations were evaluated.Results The Coflex group was significantly better than the TLIF group during the opera?tion time,intraoperative blood loss and hospital stay(P<0.01).There was no significant difference in the clinical outcome between the two groupsin the ODI(t=-0.350,P=0.728),JOA(t=0.030,P=0.976),VAS(t=0.205,P=0.839).In the active range of lum?bar spine,at final follow?up,the ROM ofsurgical segment(t=1.585,P=0.120)andupper segment of surgery(t=-1.546,P=0.129)were no significantly improved when compared withpreoperative ones in Coflex group,but in TLIF group,the ROM of surgical seg?ment(t=13.503,P<0.01)andupper segment of surgery(t=13.503,P<0.01)were statistically significant.Conclusion The lum?bar spinous process interstitial Coflex system has the same curative effect as TLIF in the treatment of lumbar degenerative diseases,and with the advantages of short operation time,low intraoperative blood loss and shorter hospital stay,with better safety,exhibiting?better performancein the preservation of lumbar spine related activities.
作者
吴晓东
雷堃
张旭
白广超
李宽新
WU Xiaodong;LEI Kun;ZHANG Xu;BAI Guangchao;LI Kuanxin(Department of Spine,Xinjiang Production and Construction Bingtuan Hospital(the Second Affiliated Hospital of the Medical College of Shihezi University),Urumqi,Xinjiang Uygur Autonomous Region 830000,China)
出处
《安徽医药》
CAS
2019年第9期1803-1807,共5页
Anhui Medical and Pharmaceutical Journal
关键词
椎间盘退行性变
临近节段退变
棘突间置入Coflex系统
腰椎
Intervertebral disc degenerative
Adjacent segment degeneration
Coflexinterspinous dynamic internal fixation
Lumbar vertebrae
