CAJ | 학술논문

目的探讨Coflex腰椎棘突间动态稳定系统治疗退行性腰椎间盘疾病的手术并发症及治疗措施.方法回顾性分析2007年11月至2011年6月采用Coflex内固定手术治疗121例退行性腰椎疾病患者资料,男76例,女45例；年龄37～75岁,平均54.6岁.其中单节段腰椎管狭窄症38例,单节段腰椎间盘突出症58例,双节段腰椎管狭窄症15例,双节段腰椎间盘突出症10例；病变节段均分布于L3.4、L4.5及L5S1间隙.记录并分析手术相关并发症及转归.结果 10例患者出现手术相关并发症,其发生率为8.3％(10/121).其中器械直接相关并发症3例,包括假体固定翼折断、假体松动及棘突骨折各1例,予观察随访,假体均未移位,未影响手术疗效.非器械相关并发症7例:术中硬膜撕裂2例,创口浅表感染1例,经相应处理均治愈；再手术4例,再手术率为3.3％(4/121),其中2例为术中减压不彻底需再次减压,1例为椎间盘突出术后复发再次行髓核摘除术,另1例为术后椎管内血肿形成经手术清除血肿后好转.结论 Coflex辅助治疗退行性腰椎疾病手术并发症发生率及再手术率均较低,且器械直接相关并发症较低,术中规范操作是降低器械直接相关并发症的关键；而严格掌握手术适应证、术中彻底有效减压是保证手术疗效、避免发生非器械相关并发症的关键.
목적 탐토Coflex요추극돌간동태은정계통치료퇴행성요추간반질병적수술병발증급치료조시.방법 회고성분석2007년11월지2011년6월채용Coflex내고정수술치료121례퇴행성요추질병환자자료,남76례,녀45례；년령37～75세,평균54.6세.기중단절단요추관협착증38례,단절단요추간반돌출증58례,쌍절단요추관협착증15례,쌍절단요추간반돌출증10례；병변절단균분포우L3.4、L4.5급L5S1간극.기록병분석수술상관병발증급전귀.결과 10례환자출현수술상관병발증,기발생솔위8.3％(10/121).기중기계직접상관병발증3례,포괄가체고정익절단、가체송동급극돌골절각1례,여관찰수방,가체균미이위,미영향수술료효.비기계상관병발증7례:술중경막시렬2례,창구천표감염1례,경상응처리균치유；재수술4례,재수술솔위3.3％(4/121),기중2례위술중감압불철저수재차감압,1례위추간반돌출술후복발재차행수핵적제술,령1례위술후추관내혈종형성경수술청제혈종후호전.결론 Coflex보조치료퇴행성요추질병수술병발증발생솔급재수술솔균교저,차기계직접상관병발증교저,술중규범조작시강저기계직접상관병발증적관건；이엄격장악수술괄응증、술중철저유효감압시보증수술료효、피면발생비기계상관병발증적관건.
Objective To investigate complications associated with Coflex interspinous process device for degenerative lumbar disc diseases and methods to treat.Methods Clinical data of 121 patients with degenerative lumbar disc diseases,who had undergone surgical decompression and additional fixation of Coflex between November 2007 and June 2011,was analyzed retrospectively.There were 76 males and 45 females,aged from 37 to 75 years (average,54.6 years).Surgery-related complications and sequelae were recorded and analyzed.Results Surgery-related complications occurred in 10 patients,and the incidence was 8.3％ (10/121).There were 3 cases of device-related complications,including wing break in 1 case,prosthetic loosening in 1 case and spinal process fracture in 1 case; all 3 cases were treated conservatively and received good results.There were 7 cases of non-device-related complications,including dura mater dilaceration in 2 cases,superficial wound infection in 1 case,insufficient decompression of spinal canal in 2 cases,recurrence of disc herniation in 1 case,and intraspinal hematoma in 1 case; the former 3 patients recovered after corresponding treatment,and the latter 4 patients also recovered after re-operation.Conclusion The incidences of complications and re-operation associated with application of Coflex are low,and the incidence of device-related complications is also low.The precise intraoperative manipulation is the key to reduce incidence of device-related complications.It's absolutely necessary to strictly master surgical indications and perform sufficient decompression in order to receive good surgical results and avoid non-device-related complications.