中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2012年
9期
782-787
,共6页
藏磊%海涌%苏庆军%鲁世保%张岑山%杨晋才%关立%康南%孟祥龙%刘铁%杜鹏
藏磊%海湧%囌慶軍%魯世保%張岑山%楊晉纔%關立%康南%孟祥龍%劉鐵%杜鵬
장뢰%해용%소경군%로세보%장잠산%양진재%관립%강남%맹상룡%류철%두붕
腰椎%椎间盘%内固定器%假体植入%手术中并发症%手术后并发症
腰椎%椎間盤%內固定器%假體植入%手術中併髮癥%手術後併髮癥
요추%추간반%내고정기%가체식입%수술중병발증%수술후병발증
Lumbar vertebrae%Intervertebral disk%Internal fixators%Prosthesis implantation%Intraoperative complications%Posteperative complications
目的 探讨腰椎棘突间动态稳定装置Coflex植入术中、术后的假体植入并发症及其应对策略.方法 对2008年9月至2010年8月133例行Coflex植入的腰椎退变性疾病患者进行回顾性研究,男性62例,女性71例；年龄35 ～ 81岁,平均60.8岁.其中出现Coflex植入并发症者1 3例,男性6例,女性7例；年龄41 ～71岁,平均58.6岁.分析Coflex植入并发症并根据不同的特点采用相应的治疗策略,对并发症患者术前、术后、保守治疗后及末次随访的视觉模拟量表( VAS)评分和Oswestry功能障碍指数(ODI)评分结果及疗效相关指标进行配对t检验.结果 13例Coflex植入并发症及其治疗包括:术中棘突断裂而改行椎弓根螺钉内固定融合3例；术后复查或随访中发现棘突断裂者2例,其中再手术椎弓根螺钉内固定融合者1例,保守治疗者1例；术前手术节段存在退变性冠状面椎间滑移者4例,矢状面不稳定者1例,术后随访中发现Coflex假体位置上移者1例患者,均有明显的疼痛加重症状并经保守治疗；1例患者术中因Coflex假体植入节段错误而改行椎弓根螺钉内固定融合；1例术后不明原因症状加重行再手术Coflex假体取出及椎弓根螺钉内固定融合.13例患者术后随访20 ～38个月,平均27.6个月；其中7例Coflex假体植入术后出现腰腿痛症状加重但Coflex假体位置仍可维持的患者,经保守治疗后末次随访VAS评分为1.9±0.7、ODI评分为23.2±3.4,较术前的6.1±1.1和58.1 ±3.0有明显改善(t=8.2和18.2,P＜0.01)；2例经再手术椎弓根螺钉翻修的Coflex植入并发症患者,其VAS及ODI评分亦有改善.结论 Coflex不宜应用于骨质疏松、棘突间距过小及椎间冠状面滑移或矢状面不稳定的病例；而假体的选择、植入深度及加持固定的力量均应适度.对于出现症状但Coflex假体位置尚能维持者,可行保守治疗；但对于假体位置差、术中植入失败或不能耐受假体者,可行椎弓根螺钉加以补救及治疗.
目的 探討腰椎棘突間動態穩定裝置Coflex植入術中、術後的假體植入併髮癥及其應對策略.方法 對2008年9月至2010年8月133例行Coflex植入的腰椎退變性疾病患者進行迴顧性研究,男性62例,女性71例；年齡35 ～ 81歲,平均60.8歲.其中齣現Coflex植入併髮癥者1 3例,男性6例,女性7例；年齡41 ～71歲,平均58.6歲.分析Coflex植入併髮癥併根據不同的特點採用相應的治療策略,對併髮癥患者術前、術後、保守治療後及末次隨訪的視覺模擬量錶( VAS)評分和Oswestry功能障礙指數(ODI)評分結果及療效相關指標進行配對t檢驗.結果 13例Coflex植入併髮癥及其治療包括:術中棘突斷裂而改行椎弓根螺釘內固定融閤3例；術後複查或隨訪中髮現棘突斷裂者2例,其中再手術椎弓根螺釘內固定融閤者1例,保守治療者1例；術前手術節段存在退變性冠狀麵椎間滑移者4例,矢狀麵不穩定者1例,術後隨訪中髮現Coflex假體位置上移者1例患者,均有明顯的疼痛加重癥狀併經保守治療；1例患者術中因Coflex假體植入節段錯誤而改行椎弓根螺釘內固定融閤；1例術後不明原因癥狀加重行再手術Coflex假體取齣及椎弓根螺釘內固定融閤.13例患者術後隨訪20 ～38箇月,平均27.6箇月；其中7例Coflex假體植入術後齣現腰腿痛癥狀加重但Coflex假體位置仍可維持的患者,經保守治療後末次隨訪VAS評分為1.9±0.7、ODI評分為23.2±3.4,較術前的6.1±1.1和58.1 ±3.0有明顯改善(t=8.2和18.2,P＜0.01)；2例經再手術椎弓根螺釘翻脩的Coflex植入併髮癥患者,其VAS及ODI評分亦有改善.結論 Coflex不宜應用于骨質疏鬆、棘突間距過小及椎間冠狀麵滑移或矢狀麵不穩定的病例；而假體的選擇、植入深度及加持固定的力量均應適度.對于齣現癥狀但Coflex假體位置尚能維持者,可行保守治療；但對于假體位置差、術中植入失敗或不能耐受假體者,可行椎弓根螺釘加以補救及治療.
목적 탐토요추극돌간동태은정장치Coflex식입술중、술후적가체식입병발증급기응대책략.방법 대2008년9월지2010년8월133례행Coflex식입적요추퇴변성질병환자진행회고성연구,남성62례,녀성71례；년령35 ～ 81세,평균60.8세.기중출현Coflex식입병발증자1 3례,남성6례,녀성7례；년령41 ～71세,평균58.6세.분석Coflex식입병발증병근거불동적특점채용상응적치료책략,대병발증환자술전、술후、보수치료후급말차수방적시각모의량표( VAS)평분화Oswestry공능장애지수(ODI)평분결과급료효상관지표진행배대t검험.결과 13례Coflex식입병발증급기치료포괄:술중극돌단렬이개행추궁근라정내고정융합3례；술후복사혹수방중발현극돌단렬자2례,기중재수술추궁근라정내고정융합자1례,보수치료자1례；술전수술절단존재퇴변성관상면추간활이자4례,시상면불은정자1례,술후수방중발현Coflex가체위치상이자1례환자,균유명현적동통가중증상병경보수치료；1례환자술중인Coflex가체식입절단착오이개행추궁근라정내고정융합；1례술후불명원인증상가중행재수술Coflex가체취출급추궁근라정내고정융합.13례환자술후수방20 ～38개월,평균27.6개월；기중7례Coflex가체식입술후출현요퇴통증상가중단Coflex가체위치잉가유지적환자,경보수치료후말차수방VAS평분위1.9±0.7、ODI평분위23.2±3.4,교술전적6.1±1.1화58.1 ±3.0유명현개선(t=8.2화18.2,P＜0.01)；2례경재수술추궁근라정번수적Coflex식입병발증환자,기VAS급ODI평분역유개선.결론 Coflex불의응용우골질소송、극돌간거과소급추간관상면활이혹시상면불은정적병례；이가체적선택、식입심도급가지고정적역량균응괄도.대우출현증상단Coflex가체위치상능유지자,가행보수치료；단대우가체위치차、술중식입실패혹불능내수가체자,가행추궁근라정가이보구급치료.
Objective To investigate device implanted complications and corresponding therapeutic strategies of Coflex interspinous dynamic stabilization system for lumbar spine intraoperatively and postoperatively.Methods From September 2008 to August 2010,133 cases of degenerative disease of lumbar spine including 62 males and 71 females,ranging from 35 to 81 years of age ( mean 60.8 years),underwent or planed to be underwent decompression with Coflex interspinous dynamic stabilization system were reviewed retrospectively,and 13 cases including 6 males and 7 females,ranging from 41 to 71 years of age (mean 58.6 years),occurred device implanted complications.The Coflex implanted complications were analyzed,and therapeutic strategies according to different character were carried out, scores of visual analogue scale (VAS),Oswestry disability index (ODI) and effect-related data preoperatively,postoperatively,after conservative treatment and in final follow-up were evaluated with paired-samples t test.Results Thirteen cases of Coflex implanted complications and treatment applied included:3 cases occurred fracture of spinous processes intraoperatively were treated by pedicle screws instead ; 2 cases occurred fracture of spinous processes postoperatively or during follow-up,including 1 case underwent revision with pedicle screws,another 1 case treated with conservative treatment; 4 cases with degenerative coronal spondylolysis in surgical segments,1 case with sagittal instability preoperatively,and 1 case with device dislodgment in follow-up all suffered aggravated pain and received conservative treatment; 1 case suffered implanted malposition intraoperatively was underwent internal fixation with pedicle screws instead; at length,1 case with aggravated pain postoperatively and without definite reason received revision with internal fixation of pedicle screws demolishing the Coflex.The follow-up time of 13 cases ranged from 20 to 38 months ( mean 27.6 months) ; and 7 cases implanted Coflex with aggravated pain of lumbar and lower limb,but the position of device can still maintained,were received conservative treatment,and whose score of VAS and ODI in the final follow-up were 1.9 ± 0.7 and 23.2 ± 3.4,and comparing to 6.1 ± 1.1 and 58.1 ± 3.0 preoperatively,evident improvement was got finally ( t =8.2 and 18.2,P ＜0.01 ).Scores of VAS and ODI of 2 cases with Coflex implanted complications underwent revision with pedicle screws were also improved correspondingly.Conclusions Coflex interspinous dynamic stabilization system implanted should be avoided to cases who suffered with osteoporosis,too narrow interspinous space and intervetebral coronal spondylolysis or sagittal instability ; and choice of device,depth of implantation and intensity of clumping should be appropriate.For patients with symptom but device still in right position,conservative treatment can be carried out; but for patients subjected to malposition of device,failure of implantation intraoperatively or intolerating to device,revisions and salvages should be underwent with internal fixation of pedicle screws.
