Coflex动态稳定装置在L5/S1退变性疾病中的应用

Use of Coflex interspinous dynamic stabilization device for L5/S1 degenerative disease

中文关键词:  腰椎退变性疾病  非融合术  棘突间动态稳定装置  Coflex装置  L5/S1

英文关键词:Lumbar degenerative disease  Nonfusion  Interspinous dynamic stabilization device  Coflex  L5/S1

中文摘要:

  【摘要】 目的：探讨Coflex动态稳定装置在L5/S1退变性疾病中应用的可行性及其临床效果。方法：首先在腰椎CT像上测量100例（男女各50例）骶骨发育正常成人S1棘突的解剖参数和Coflex假体的大小，并进行比较。然后于2007年11月~2010年2月对46例腰椎退变性疾病患者在椎管减压后棘突间置入Coflex动态稳定装置，按置入节段不同，分为L4/5组和L5/S1组。L4/5组患者25例，年龄33~73岁，平均50.6岁，随访17~39个月，平均25个月；L5/S1组21例，年龄34~65岁，平均48.8岁，随访16~38个月，平均24个月。观察术前和末次随访时Oswestry功能障碍指数（ODI）、VAS疼痛评分，手术节段椎体间背侧高度、腹侧高度和椎间孔高度，手术节段和上相邻节段活动度（ROM）及上相邻节段椎间盘MRI信号Pfirmann分级。结果：男性S1棘突的长、宽、高分别为20.48±5.82mm、14.94±3.56mm、18.78±5.08mm，女性分别为18.81±3.45mm、11.58±2.95mm、17.39±3.72mm；与Coflex假体比较，70例S1棘突能支撑假体，30例S1棘突过短但通过将Coflex假体倒置置入可得到解决。两组患者均成功置入Coflex假体，L5/S1组12例因S1棘突过短而将Coflex假体倒置置入。两组患者术中及术后均无严重并发症发生，末次随访时ODI及VAS评分较术前有明显改善（P＜0.05），各时间点组间比较无显著性差异（P＞0.05）。末次随访时两组患者手术节段椎体间腹侧高度、背侧高度及椎间孔高度均较术前明显增高（P＜0.05），手术节段ROM均较术前减少（P＜0.05），上位相邻节段ROM较术前无明显改变（P＞0.05），以上各指标末次随访时的变化程度两组之间无显著性差异（P＞0.05）。L4/5组5例、L5/S1组1例上相邻节段椎间盘MRI信号分级加重1级。结论：在椎管减压后置入Coflex动态稳定装置治疗L5/S1退变性疾病可行且有效。

英文摘要:

  【Abstract】 Objective：To investigate the feasibility and clinical efficacy of Coflex interspinous dynamic stabilization device for L5/S1 degenerative disease.Method：Anatomic parameters of S1 interspinous process and Coflex prosthesis were measured in CT scan on 100 cases（50 males and 50 females） with normal adult sacrum.Then 46 cases with lumbar degenerative disease underwent Coflex implantation after laminectomy from November 2007 to February 2011.All cases were divided into two groups based on surgical levels（L4/5 and L5/S1）.There were 25 L4/5，with an average age of 50.6 years（range，33 to 73 years） and an average follow-up of 25 months（range，17 to 39 months）；L5/S1 group included 21 cases，with an average age of 48.8 years（range，34 to 65 years） and an average follow-up of 24 months（range，16 to 38 months）.Visual analogue scale（VAS），Oswestry disability index（ODI），ventral intervertebral space height（VH），dorsal intervertebral space height（DH），intervertebral foramen height（IFH），the range of motion（ROM），Pfirmann classification of lumbar discs′ MRI signal were used to review the radiographic and clinical outcome.Result：The average length，width and depth of S1 spinous process for male was 20.48±5.82mm，14.94±3.56mm and 18.78±5.08mm respectively，while those for female was 18.81±3.45mm，11.58±2.95mm and 17.39±3.72mm respectively.Of these，70 cases had enough long S1 spinous process which could hold Coflex，while the S1 spinous process in the other 30 cases was so short that the prosthesis must be placed reversely.Coflex was placed in all cases of 2 groups.No serious complications were found in both groups.The ODI，VAS，VH，DH and IFH at final follow-up improved significantly（P<0.05）.ROM of surgical level decreased（P<0.05），and ROM at caudal adjacent segment remained no change in both groups（P>0.05）.No significant differences with respect to all parameters were noted in two groups（P>0.05）.5 patients in L4/5 group had MRI grade of caudal adjacent disc increased 1 level，while 1 case in L5/S1 group had MRI grade of caudal adjacent disc increased 1 level.Conclusion：Coflex implantation after laminectomy for L5/S1 degenerative disease is feasible and effective.