CAJ | 학술논문

目的通过单纯髓核摘除术与加用Coflex棘突间动态稳定系统治疗腰椎间盘突出症的疗效对比研究,评价Coflex在治疗腰椎间盘突出症中的应用价值.方法 2007年11月至2008年8月分别采用单纯髓核摘除术与加用Coflex棘突间动态稳定系统治疗腰椎间盘突出症50例,男性31例,女性19例；年龄30 ～72岁,平均52.5岁.病史6～48个月,平均15.6个月.其中单纯髓核摘除组26例,Coflex固定组24例.通过视觉模拟量表(VAS)评分、日本骨科协会(JOA)评分、Oswestry功能障碍指数(ODI)评分和影像学分析,采用配对t检验及单向方差分析,评价Coflex动态稳定系统在治疗腰椎间盘突出症中的价值.结果单纯髓核摘除组与Coflex固定组在JOA、ODI、VAS评分上较术前均有显著改善(t=-33.2～64.5,P＜0.01),但单纯髓核摘除术组末次随访ODI评分显著增加,由术后12个月的6.7±1.5增加到10.2±2.3(t=-19.3,P＜0.05).影像学显示Coflex固定组手术前后手术节段椎间盘背侧高度(HD)、椎间孔间最大距离(DIF)、棘突顶距(DS)及椎管面积(SA)均明显增加(t=-34.4～4.5,P＜0.05).单纯髓核摘除术组上述指标则显著减小(t=3.4 ～52.8,P ＜0.05).Coflex固定组在HD、DIF、DS上均高于单纯髓核摘除组,差异具有统计学意义(F=14.1～25.6,P＜0.05).结论腰椎间盘突出单纯髓核摘除术与加用Coflex治疗腰椎间盘突出症均有显著疗效,但Coflex固定组确实增加了椎间盘背侧高度和椎间孔间最大距离,在近中期疗效、防止腰椎退变方面明显优于单纯髓核摘除组.
목적 통과단순수핵적제술여가용Coflex극돌간동태은정계통치료요추간반돌출증적료효대비연구,평개Coflex재치료요추간반돌출증중적응용개치.방법 2007년11월지2008년8월분별채용단순수핵적제술여가용Coflex극돌간동태은정계통치료요추간반돌출증50례,남성31례,녀성19례；년령30 ～72세,평균52.5세.병사6～48개월,평균15.6개월.기중단순수핵적제조26례,Coflex고정조24례.통과시각모의량표(VAS)평분、일본골과협회(JOA)평분、Oswestry공능장애지수(ODI)평분화영상학분석,채용배대t검험급단향방차분석,평개Coflex동태은정계통재치료요추간반돌출증중적개치.결과 단순수핵적제조여Coflex고정조재JOA、ODI、VAS평분상교술전균유현저개선(t=-33.2～64.5,P＜0.01),단단순수핵적제술조말차수방ODI평분현저증가,유술후12개월적6.7±1.5증가도10.2±2.3(t=-19.3,P＜0.05).영상학현시Coflex고정조수술전후수술절단추간반배측고도(HD)、추간공간최대거리(DIF)、극돌정거(DS)급추관면적(SA)균명현증가(t=-34.4～4.5,P＜0.05).단순수핵적제술조상술지표칙현저감소(t=3.4 ～52.8,P ＜0.05).Coflex고정조재HD、DIF、DS상균고우단순수핵적제조,차이구유통계학의의(F=14.1～25.6,P＜0.05).결론 요추간반돌출단순수핵적제술여가용Coflex치료요추간반돌출증균유현저료효,단Coflex고정조학실증가료추간반배측고도화추간공간최대거리,재근중기료효、방지요추퇴변방면명현우우단순수핵적제조.
Objective To compare clinical efficacy between discectomy and discectomy plus Coflex fixation for lumbar disc herniation.Methods From December 2007 to August 2008,50 patients(31 males and 19 females)were treated by surgery of discectomy and discectomy plus Coflex fixation.The average age was 52.5 years(range,30-72 years).There were 24 cases in the group of discectomy plus Coflex fixation and 26 cases in the group of discectomy.Preoperative and postoperative visual analogue scales(VAS),Japanese Orthopadic Association(JOA)and Oswestry disability index(ODI)were recorded,as well as radiological index.And use a paired t-test and one-way analysis of variance(one-way ANOVA)statistical method to evaluate the Coflex dynamic stabilization system in value in the treatment of lumbar disc herniation.Results Both groups received significant improvement of JOA,ODI and VAS(t =-33.2-64.5,P ＜ 0.01),but the group of discectomy was found with deterioration of ODI at last follow-up,12 months after surgery 6.7 ± 1.5 to 10.2 ± 2.3(t =-19.3,P ＜ 0.05).The group of discectomy plus Coflex fixation was found with significant increase of height of dorsal intervertebral discs(HD),distance across the two adjacent spinous processes(DS),distance of intervertebral foramina(DIF)and spinal canal area(SA)(t =-34.4-4.5,P ＜ 0.05).In contrast,the group of discectomy was found with significant decrease of HD,DS,DIF and SA(t =3.4-52.8,P ＜0.05).Coflex fixed group in HD,DIF,DS significant difference with simple discectomy group,with a statistically significant(F =14.1-25.6,P ＜ 0.05).Conclusions Both discectomy and discectomy plus Coflex fixation are apparently effective when treating lumbar disc herniation.Coflex can significantly increase the HD and DIF when used for lumbar disc herniation,and it has positive influence for keeping height of lumbar vertebral space and treating the nerve root symptom of lumbar disc herniation.Discectomy plus Coflex is better than pure discectomy in preventing lumbar degeneration.