CAJ | 학술논문

背景：近几年来国内各大医院广泛采用Coflex治疗腰椎间盘突出症及腰椎管狭窄症，并取得了良好的治疗效果。 　　目的：探讨Coflex棘突间动态稳定装置治疗腰椎退变性疾病的疗效，并通过随访治疗后椎间孔高度的变化及内固定后腰椎功能恢复情况来探讨椎间孔撑开高度与临床疗效之间的关系。 　　方法：行Coflex植入内固定治疗腰椎间盘突出及腰椎管狭窄症的病例，随访患者的椎间孔的高度、椎体前缘及后缘高度。记录患者内固定治疗前、治疗后1年及末次随访时的ODI及目测类比评分值。 　　结果与结论：内固定治疗后患者的椎间隙前缘高度、椎间隙后缘高度及椎间孔高度较内固定前均有明显的增高，治疗后1周内复查的X射线平片显示椎间孔及椎间隙高度达到最大值，此后随着随访时间的延长，各高度均随着时间的延长而不同程度的下降。在平均内固定后26.4个月随访时的椎间隙高度及椎间孔高度较内固定前的高度仍具有显著差异。根据ODI功能评分及目测类比评分疼痛评分结果，治疗后3个月即可见患者功能明显改善，在内固定后1年左右进一步改善，腰椎功能恢复效果达到最佳，末次随访时ODI评分值与内固定后1年随访值的差异无显著性意义。说明Coflex治疗腰椎间盘突出症及轻中度腰椎管狭窄症可取的较为理想的治疗效果，其治疗的效果主要来自于术中对硬膜及神经根的减压，而Coflex对椎间孔高度的恢复随着随访时间的延长会逐渐丢失。
배경：근궤년래국내각대의원엄범채용Coflex치료요추간반돌출증급요추관협착증，병취득료량호적치료효과。 　　목적：탐토Coflex극돌간동태은정장치치료요추퇴변성질병적료효，병통과수방치료후추간공고도적변화급내고정후요추공능회복정황래탐토추간공탱개고도여림상료효지간적관계。 　　방법：행Coflex식입내고정치료요추간반돌출급요추관협착증적병례，수방환자적추간공적고도、추체전연급후연고도。기록환자내고정치료전、치료후1년급말차수방시적ODI급목측류비평분치。 　　결과여결론：내고정치료후환자적추간극전연고도、추간극후연고도급추간공고도교내고정전균유명현적증고，치료후1주내복사적X사선평편현시추간공급추간극고도체도최대치，차후수착수방시간적연장，각고도균수착시간적연장이불동정도적하강。재평균내고정후26.4개월수방시적추간극고도급추간공고도교내고정전적고도잉구유현저차이。근거ODI공능평분급목측류비평분동통평분결과，치료후3개월즉가견환자공능명현개선，재내고정후1년좌우진일보개선，요추공능회복효과체도최가，말차수방시ODI평분치여내고정후1년수방치적차이무현저성의의。설명Coflex치료요추간반돌출증급경중도요추관협착증가취적교위이상적치료효과，기치료적효과주요래자우술중대경막급신경근적감압，이Coflex대추간공고도적회복수착수방시간적연장회축점주실。
BACKGROUND:Recently, Coflex was widely used in hospital in China for the treatment of lumbar disc herniation and lumbar spinal stenosis, and obtained perfect therapeutic effects. OBJECTIVE:To discuss the curative effect of treating lumbar degenerative diseases by Coflex interspinal device, and to explore the relationship between foraminal height and the curative effect by comparing the change of foraminal height and the change of lumbar function. METHODS:Coflex implantation for lumbar disc herniation and lumbar spinal stenosis was performed. The foraminal height and the heights of anterior and posterior borders were investigated. ODI and visual analogue scale before internal fixation, at 1 year after treatment and during fol ow-up were recorded. RESULTS AND CONCLUSION:The foraminal height and the heights of anterior and posterior borders were obviously increased after internal fixation. At 1 week after treatment, radiographs exhibited that the foraminal height and intervetebral height were maximal. The foraminal height and the heights of anterior and posterior borders decreased with prolonged fol ow-up time. At 26.4 months after mean internal fixation, significant differences in the foraminal height and intervetebral height were detected as compared with pre-fixation. Results of ODI and visual analogue scale demonstrated that patients’ functions were significantly improved at 3 months after treatment, and further improved at about 1 year after fixation. The recovery of lumbar vertebra function was optimal. No significant difference in ODI score was detectable between final fol ow-up and 1-year fixation. These results suggested that Coflex for lumbar disc herniation and mild and moderate lumbar spinal stenosis obtained ideal therapeutic effects. Its therapeutic effects mainly originate from the intraoperative decompression on dura mater and nerve root. However, Coflex effects on the recovery of foraminal height gradual y lost with prolonged fol ow-up time.