棘突间动态稳定装置在脱出/游离型腰椎间盘突出症患者中的应用

Application of interspinous dynamic stabilization system for prolapsed or sequestered type of lumbar disc herniation

中文关键词:  【关键词】 腰椎间盘突出症  棘突间动态稳定装置  疗效

英文关键词:【Key words】 Lumbar disc herniation  Interspinous dynamic stabilization system  Outcome

中文摘要:

  【摘要】 目的：观察棘突间动态稳定装置在脱出/游离型腰椎间盘突出症患者中应用的长期疗效。方法：2007年5月～2009年4月我院治疗脱出或游离型腰椎间盘突出症且有完整随访资料的患者59例，其中采用髓核摘除联合棘突间动态稳定装置（Coflex）置入31例（Coflex组），男20例，女11例，年龄28～52岁（42.1±8.9岁）；单纯髓核摘除28例（对照组），男17例，女11例，年龄30～54岁（41.5±9.5岁）。术前所有患者均有臀部及下肢放射样疼痛或麻木，直腿抬高试验阳性。经MRI检查证实为L4/5椎间盘突出，脱出或游离型，经过保守治疗3个月以上效果不明显。在术前、术后3个月、1年、3年及5年，对两组患者行腰腿痛VAS评分和JOA评分，定期行腰椎正侧位、过伸过屈位X线片检查，末次随访时行MRI检查。两组计量资料比较采用t检验或方差分析，等级资料比较采用秩和检验。结果：两组病例术后随访61～69个月（65±4个月）。随访期间Coflex组未发现棘突骨折和置入物移位等并发症。两组术后各时间点腰痛VAS、下肢痛VAS、JOA评分均较术前明显改善（t=6.35～24.2，Ｐ<0.05）；Coflex组在末次随访时腰痛VAS较对照组低，但差异无统计学意义（t=2.12，Ｐ>0.05）；Coflex组手术节段椎间盘后侧高度（pDH）在术后3年及末次随访时与对照组的差异具有统计学意义（t=5.36和t=7.53，Ｐ<0.05）；Coflex组手术节段的椎间盘退变分级（MRI，Pfirmann）在术后5年随访时优于对照组（Z=2.85，Ｐ<0.05）；Coflex组未见术后复发，对照组有1例术后复发。结论：髓核摘除联合棘突间动态稳定装置治疗脱出/游离型腰椎间盘突出症能够延缓手术节段椎间盘高度丢失和进一步退变，且可能减少术后椎间盘突出的复发，长期随访效果良好。

英文摘要:

  【Abstract】 Objectives: To evaluate the long-term outcome of interspinous dynamic stabilization system(Coflex) for prolapsed or sequestered type of lumbar disc herniation, and to compare with discectomy retrospectively. Methods: 59 patients with prolapsed or sequestered type of lumbar disc herniation in our department during the period from May 2007 to April 2009 were studied retrospectively. The group of discectomy plus Coflex included 20 males and 11 females, with the age ranging from 28 to 52 years(mean 42.1±8.9 years). The control group undergoing only discectomy included 17 males and 11 females, with the age ranging from 30 to 54 years(mean 41.5±9.5 years). All the patients presented with the pain in hips and lower limbs or numbness with sign of positive straight leg raising test. All were diagnosed as prolapsed or sequestered type of lumbar disc herniation through MRI. Conservative treatment had no effects after more than 3 months. Before operation, 3 months, 1 year, 3 years and 5 years after operation, VAS of pain in low back and lower limbs, JOA score were recorded. Patients had regular lumbar X-ray, dynamic X-ray and MRI in the final follow-up. t test and variance analysis statistics and rank-sum test were used. Results: The patients were followed up. The mean follow-up time was 65±4 months(from 61 to 69 months). During the follow-up, the complications such as fracture of spinous process and implant displacement were not observed. At each time point after operation, low back and lower limb VAS, JOA scores of the two groups significantly improved compared with the preoperative indexs(t=6.35-24.2, Ｐ<0.05). VAS of low back pain in Coflex group at final follow-up was lower than that in control group, but the difference was not statistically significant(t=2.12, Ｐ>0.05). At 3 years after operation and final follow-up, posterior disc height(pDH) in Coflex group showed significant difference with that in the control group(t=5.36 and t=7.53, separately, Ｐ<0.05). Scale of disc degeneration in Coflex group was better than that in the control group at 5 years of follow-up(Z=2.85, Ｐ<0.05). Discectomy combined with Coflex group had no recurrence, while one case in the control group was noted recurrence. Conclusions: Disc height maintaining and delaying the degeneration of disc is noted with Coflex for prolapsed or sequestered type of LDH, which may decrease the recurrence rate of lumbar disc herniation. Long-term results remian good.