椎管减压棘突间Coflex置入术治疗L4/5退变性腰椎管狭窄症的5年随访结果

Result of 5-year follow-up of lumbar spinal decompression plus Coflex interlaminar placement for degenerative lumbar spinal stenosis

中文关键词:  【关键词】 退变性腰椎管狭窄症  Coflex  非融合技术  后路椎间融合术

英文关键词:【Key words】 Degenerative lumbar stenosis  Coflex  Non-fusion technique  Posterior interbody fusion

中文摘要:

  【摘要】 目的：分析椎管减压棘突间Coflex置入术治疗L4/5退变性腰椎管狭窄症的5年临床有效性和安全性。方法：2008年4月~2009年5月行手术治疗且随访不少于5年的L4/5退变性腰椎管狭窄症患者103例。其中50例采用黄韧带切除减压、棘突间Coflex置入术（Coflex组），53例采用椎板减压、椎间融合固定术（融合组），手术节段均为L4/5。记录两组患者术前、术后2年及术后5年时的JOA评分、ODI及VAS评分；测量术前、术后2年及术后5年时的手术相邻节段（L3/4及L5/S1）椎间隙高度及椎间活动度；采用UCLA评分评价相邻节段退变情况；记录并发症情况。通过统计学分析，评价两种方法的有效性和安全性。结果：Coflex组随访时间为5.43±0.21年，融合组随访时间为5.52±0.28年。术后2年及5年随访时JOA评分、ODI及VAS评分两组比较差异无统计学意义（P>0.05）。Coflex组术后2年及5年上下相邻节段椎间高度和活动度与术前比较无统计学差异（P>0.05）；融合组术后2年、5年的上位椎间活动度及术后5年下位椎间活动度大于术前，差异有统计学意义（P<0.05）；融合组术后2年及5年上下位椎间活动度均大于Coflex组，差异有统计学意义（P<0.05）；融合组术后5年上位节段椎间高度小于术前，与Coflex组术后5年椎间高度相比差异有统计学意义（P<0.05）。Coflex组并发症发生率为12%、融合组为9.4%；Coflex组再手术率为8%、融合组为5.6%，两组间均无统计学差异（P>0.05）。融合组手术相邻节段退变发生率为13.2%，Coflex组为6%，差异无统计学意义（P>0.05）。结论：椎管减压、棘突间Coflex置入术治疗L4/5退变性腰椎管狭窄症术后5年的临床疗效与传统腰椎融合术相似，且能有效避免融合手术所致的手术相邻节段椎间活动度过大问题，但对延缓相邻节段退变的作用有待更长期的观察。

英文摘要:

  【Abstract】 Objectives: To observe the clinical efficacy and safety of lumbar spinal decompression plus Coflex interlaminar placement for degenerative lumbar spinal stenosis. Methods: 103 patients undergoing surgery for degenerative lumbar spinal stenosis between April 2008 and May 2009 were followed up. 50 cases underwent coflex interlaminar placement with yellow ligament resection（coflex group）, while 53 patients were treated with laminectomy and lumbar interbody fusion(fusion group). The JOA, ODI and VAS scores were used to assess the clinical effects between two groups. The range of motion(ROM) and disc height of adjacent segments were measured pre-operatively and post-operatively. The outcome and safety were evaluated statistically. Results: The average follow-up for Coflex group was 5.43±0.21 years and 5.52±0.28 years for fusion group. There was no significant difference for JOA score, ODI score or VAS score between two groups at 2 years and 5 years of follow-up(P>0.05). There was no significant difference(P>0.05) for ROM or disc height of adjacent segments in Coflex group between pre-operation and 2 or 5-year post-operation. In fusion group, at 2 and 5 years after surgery, the ROM of upper disc significantly increased compared with that at pre-operation(P<0.05), and the ROM of lower disc also significantly increased at 5 years after surgery compared with that of pre-operation(P<0.05). In fusion group, at 2 and 5 years after surgery, ROM of upper and lower disc both increased compared with that in Coflex group(P<0.05). In fusion group, at 5 years after surgery, the upper disc height was lower than that at pre-operation(P<0.05), while higher than that in Coflex group(P<0.05). The rate of complication in Coflex group was 12%, while 9.4% in fusion group. The reoperation rate in Coflex group was 8%, and 5.6% in fusion group, which showed no statistical difference between two groups(P>0.05). The incidence of adjacent segment disease in fusion group was 13.2%, while 6% in Coflex group, which showed no statistical difference between two groups(P>0.05). Conclusions: The clinical outcome of Coflex implantation and traditional lumbar fusion is consistent. 5-year follow-up reveals the advantage of Coflex in maintaining the motion of adjacent level. However, its result needs long-term observation.