CAJ | 학술논문

目的：探讨Coflex棘突间动态内固定系统治疗退行性腰椎管狭窄症的近期临床疗效。方法采用腰椎后路椎管减压棘突间植入Coflex棘突间动态内固定系统治疗23例退行性腰椎管狭窄症的患者。患者术前均接受腰椎MRI和CT扫描，证实相应节段因各个原因继发腰椎管狭窄。在患者术前及术后不同时间的腰椎正、侧位及动力位X线片上测量手术间隙椎间隙前、后缘高度及椎间活动范围，采用VAS评分及JOA评分标准进行功能评估。结果患者均获随访，时间15~24个月。术后患者腰腿痛症状及间歇性跛行均明显缓解，日常生活能力改善。术后3、12个月及末次随访时的VAS评分较术前明显下降，末次随访较术后3、12个月下降，差异有统计学意义( P<0．05)；JOA评分由术前的(14．65±3．80)分改善至术后3个月的(25．12±1．96)分(P<0．05)。椎间隙后缘高度及椎间孔高度较术前增加(P<0．05)，椎间隙前缘高度较术前略有下降，但差异无统计学意义(P>0．05)；手术节段仍保持一定活动度，但较术前有明显下降(P<0．05)。所有患者均未出现Coflex系统松动、断裂、脱出及相应棘突的骨折等并发症。结论 Coflex棘突间动态内固定系统治疗退行性腰椎管狭窄症可较好地维持相应节段的稳定性、手术节段椎间隙、椎间孔的高度及活动度，近期疗效满意。
목적：탐토Coflex극돌간동태내고정계통치료퇴행성요추관협착증적근기림상료효。방법채용요추후로추관감압극돌간식입Coflex극돌간동태내고정계통치료23례퇴행성요추관협착증적환자。환자술전균접수요추MRI화CT소묘，증실상응절단인각개원인계발요추관협착。재환자술전급술후불동시간적요추정、측위급동력위X선편상측량수술간극추간극전、후연고도급추간활동범위，채용VAS평분급JOA평분표준진행공능평고。결과환자균획수방，시간15~24개월。술후환자요퇴통증상급간헐성파행균명현완해，일상생활능력개선。술후3、12개월급말차수방시적VAS평분교술전명현하강，말차수방교술후3、12개월하강，차이유통계학의의( P<0．05)；JOA평분유술전적(14．65±3．80)분개선지술후3개월적(25．12±1．96)분(P<0．05)。추간극후연고도급추간공고도교술전증가(P<0．05)，추간극전연고도교술전략유하강，단차이무통계학의의(P>0．05)；수술절단잉보지일정활동도，단교술전유명현하강(P<0．05)。소유환자균미출현Coflex계통송동、단렬、탈출급상응극돌적골절등병발증。결론 Coflex극돌간동태내고정계통치료퇴행성요추관협착증가교호지유지상응절단적은정성、수술절단추간극、추간공적고도급활동도，근기료효만의。
Objective To investigate the recent clinical efficacy of spinal non-fusion interspinous Coflex system for the degenerative lumbar spinal stenosis. Methods 23 cases with degenerative lumbar spinal stenosis were treated by decompression with posterior spinous process and interspinous dynamic internal fixation with Coflex system. All cases were scanned by MRI and CT to confirm the segments with degenerative lumbar spinal stenosis. Lumbar anteroposteri-or, lateral and flexion-extension X-ray films preoperatively, and at follow-up time were used to measure the following parameters:the anterior and posterior disc space height, foraminal height, the range of motion at surgical level. VAS scores and JOA scores for preoperative and postoperative were used for functional assessment. Results All patients were followed up for 15~24 months. Patients with low back pain and intermittent claudication were significantly alle-viated postoperatively and activities of daily living were improved. The time in three months,12 months and last follow-up postoperatively compared with the preoperative VAS score decreased significantly. The last follow-up compared with three months and 12 months postoperatively decline,and there was no statistically significant (P<0. 05). The JOA scores improved from 14. 65 ± 3. 80 in preoperative cases to 25. 12 ± 1. 96 in postoperative cases for 3 months after surgery(P<0. 05). The disc space posterior height in postoperative cases increased compared with the preoperative cases significantly (P<0. 05), and gradually decreased with time. Single segment anterior disc space height did not change significantly, the difference was not statistically significant ( P>0. 05 ) . The operative segment still keep a range of motion after surgery, but the motion decreased significantly (P<0. 05) compared with the preoperative. No patients suffered Coflex loosening, fracture and emerge. Conclusions The treatment of lumbar spinal stenosis with Coflex system has satisfactory effect in minimal invasiveness and high security, which provides a safe and effective therapy for degenerative lumbar spinal stenosis. The system can maintain disc height and foraminal height, which is aimed to decrease the ROM of surgical level, its mid-term efficacy is reliable.