CAJ | 학술논문

目的评价采用Coflex棘突间动态内固定植入术治疗腰痛的临床疗效及相关影像学改变.方法 2007年2月至2009年6月,对45例患者行Coflex棘突间内固定植入术,男26例,女19例;年龄45～70岁,平均51.4岁.治疗节段:L4.5 32例,L5S111例,L4.5、L5S1双节段2例.手术采用椎板开窗或部分切除,椎管减压后棘突间植入Coflex装置.按照Oswestry功能障碍指数(Oswestry disabi1ity index,ODI)和日本矫形外科学会(Japanese Orthopaedic Association,JOA)评分评价术前及术后随访时的临床疗效,计算恢复率.同时行影像学观察,包括椎间隙高度和椎间孔形态,手术节段椎体活动度和腰椎生理曲度,手术及相邻节段的MRI信号改变.结果术后随访时间1O-34个月,平均24个月.ODI由术前62.82±10.42降至末次随访时11.80±3.35;JOA评分由9.00±2.63提高至24.65±1.86;最终疗效评价为显效的患者共40例,显效率为89%.L4.5、L5S1节段术后Cobb角分别为15.1°±3.9°和16.3°±3.8°,均较术前减小,生理曲度改善.L4.5节段椎体活动度(range of motion,ROM)由术前6.5°±1.5°增加至术后8.4°±2.6°,而L5S1节段ROM手术前后没有明显改变.无论是L4.5或是L5S1节段,末次随访时其椎间隙背侧高度、棘突顶距、椎间孔高度和椎间孔面积均较术前显著增加.结论 Coflex棘突间动态内固定中期随访临床疗效显著,并且保留了腰椎生理曲度和节段运动,增加并维持椎间隙高度和椎间孔面积,在手术节段椎间盘修复及防止相邻节段椎间盘退变等方面作用显著.
목적 평개채용Coflex극돌간동태내고정식입술치료요통적림상료효급상관영상학개변.방법 2007년2월지2009년6월,대45례환자행Coflex극돌간내고정식입술,남26례,녀19례;년령45～70세,평균51.4세.치료절단:L4.5 32례,L5S111례,L4.5、L5S1쌍절단2례.수술채용추판개창혹부분절제,추관감압후극돌간식입Coflex장치.안조Oswestry공능장애지수(Oswestry disabi1ity index,ODI)화일본교형외과학회(Japanese Orthopaedic Association,JOA)평분평개술전급술후수방시적림상료효,계산회복솔.동시행영상학관찰,포괄추간극고도화추간공형태,수술절단추체활동도화요추생리곡도,수술급상린절단적MRI신호개변.결과 술후수방시간1O-34개월,평균24개월.ODI유술전62.82±10.42강지말차수방시11.80±3.35;JOA평분유9.00±2.63제고지24.65±1.86;최종료효평개위현효적환자공40례,현효솔위89%.L4.5、L5S1절단술후Cobb각분별위15.1°±3.9°화16.3°±3.8°,균교술전감소,생리곡도개선.L4.5절단추체활동도(range of motion,ROM)유술전6.5°±1.5°증가지술후8.4°±2.6°,이L5S1절단ROM수술전후몰유명현개변.무론시L4.5혹시L5S1절단,말차수방시기추간극배측고도、극돌정거、추간공고도화추간공면적균교술전현저증가.결론 Coflex극돌간동태내고정중기수방림상료효현저,병차보류료요추생리곡도화절단운동,증가병유지추간극고도화추간공면적,재수술절단추간반수복급방지상린절단추간반퇴변등방면작용현저.
Objective To evaluate the mid-term clinical effects and the imaging changes of Coflex interspinous dynamic internal fixation for low back pain. Methods From February 2007 to June 2009,Coflex interspinous dynamic internal fixation was performed in a consecutive 45 patients. They included 26 males and 19 females, with an average of 51.4 years ranging in age from 45 to 70 years. Thirty-two cases were in L4.5 level, 11 in L5S1 level and 2 in both two levels. The patients were treated with limited laminectomy and implanted with Coflex device. Clinical outcomes were assessed by Oswestry disability index (ODI)scores and Japanese Orthopaedic Association (JOA) questionnaires before and after operation. The imaging examination was obtained to assess height of the intervertebral space, area of the intervertebral foramen,segment movement of the operation level, low lumbar curvature and signal of the lumbar disc on MRI. Results The follow-up time ranged from 10 to 34 months, with an average of 24 months. The ODI scores decreased significantly from 62.82±10.42 preoperatively to 11.80±3.35 postoperatively. The JOA scores were improved remarkably from 9.00±2.63 preoperatively to 24.65±1.86 postoperatively. The proportion with optimal effect was 89% (40 cases). The Cobb angle after operation of L4.5 and L5S1 level was 15.1°±3.9° and 16.3°±3.8° respectively, which was significantly decreased after operation. The range of motion of the L4.5 level increased from 6.5°±1.5° to 8.4°±2.6° while the L5S1 level did not change notedly. The heights of the dorsal intervertebral disc, distance of the spinous processes, intervertebral foramen height and area were significantly higher than those before operation. Conclusion The Coflex interspinous dynamic internal fixation is available to reserve segment movement, to increase intervertebral space height and foramen area. Meanwhile,it is effective to self-repair and prevent degeneration for the disc in adjacent levels.