摘要
目的比较单节段Coflex棘突间动力重建与后路360°植骨融合治疗L4、5退变性疾病的临床疗效与影像改变。方法对2008年10月-2010年11月采用后路减压联合Coflex棘突间动力重建术(A组,29例)治疗与后路减压、椎间及后外侧360°植骨融合术(B组,31例)治疗并获完整随访的L4、5退变性疾病患者进行对比研究。A组:男20例,女9例;年龄21～67岁,平均45.1岁;病程2个月～4年。B组:男16例,女15例;年龄32～86岁,平均56.2岁;病程3个月～6年。除年龄外,两组性别、病程、病因等差异均无统计学意义(P>0.05)。术前及末次随访时对患者行日本骨科协会(JOA)评分、疼痛视觉模拟评分(VAS)、功能障碍指数(ODI)量表评定,并摄X线片测量病变节段及其上下节段椎间高度、椎间活动度及腰椎整体活动度。结果 A、B组手术时间及出血量比较,差异均有统计学意义(P<0.05)。A组术后并发脑脊液漏2例;B组术中并发硬膜撕裂1例、椎管内静脉丛出血1例,术后脑脊液漏2例;两组并发症发生率差异无统计学意义(χ2=0.119,P=0.731)。A组随访时间12～21个月,B组为12～23个月。末次随访时A、B组VAS、JOA评分及ODI均优于术前(P<0.05);且A组VAS评分优于B组(P<0.05)。A、B组手术前后L4、5及L5、S1椎间高度比较差异均无统计学意义(P>0.05);A组L3、4椎间高度手术前后比较差异无统计学意义(P>0.05),而B组较术前降低(P<0.05)。A、B组手术前后L5、S1椎间活动度及腰椎整体活动度比较差异无统计学意义(P>0.05);A组L4、5椎间活动度较术前减少(P<0.05),而L3、4椎间活动度与术前比较差异无统计学意义(P>0.05);B组末次随访时L4、5椎间隙已融合,L3、4椎间活动度较术前增大(P<0.05)。末次随访时,A、B组间L3、4椎间高度及椎间活动度比较差异有统计学意义(P<0.05),其余各指标比较差异均无统计学意义(P>0.05)。结论 单节段Coflex棘突间动力重建与后路360°植骨融合术治疗L4、5退变性疾病疗效相当,但前者对邻近节段具有保护作用,更适用于青壮年初治及年老体弱复发患者。
Objective To compare the effectiveness and radiological changes of posterior decompression combined with Coflex interspinous dynamic reconstruction or lumbar 360° fusion for degenerative lumbar spinal disorders at L4.5. Methods Between October 2008 and November 2010, a comparative study was carried out on patients with degenerative lumbar spinal disorders at L4. 5. In group A, 29 patients underwent posterior decompression combined with Coflex interspinous dynamic reconstruction; there were 20 males and 9 females with an average age of 45.1 years （range, 21-67 years）; and the disease duration was 2 months to 4 years. In group B, 31 patients underwent posterior decompression combined with lumbar 360° fusion treatment; there were 16 males and 15 females with an average age of 56.2 years （range, 32-86 years）; and the disease duration was 3 months to 6 years. Except the age, there was no significant difference in gender, disease duration, and etiology etc. between 2 groups （P 〉 0.05）. The results were assessed by Japanese Orthopaedic Association （JOA）, visual analogue scale （VAS） scores, and Oswestry disability index （ODI）. The range of motion （ROM） and intervertebral height of affected and adjacent segments, and the ROM of lumbar were measured before operation and last follow-up. Results Significant differences were found in the operative time and blood loss between 2 groups （P 〈 0.05）. Intraoperative dural tear occurred in 1 case of group B, spinal canal venous plexus hemorrhage in 1 case of group B, and postoperative cerebrospinal fluid leakage in 2 cases of group A and B respectively, showing no significant difference （Z2=0.119, P=0.731）. The follow-up was 12-21 months in group A and was 12-23 months in group B. At the last follow-up, the JOA, VAS scores, and ODI of groups A and B were significantly improved when compared with the preoperative values （P 〈 0.05）. The VAS score of group A was significantly higher than that of group B （P 〈 0.05）. There was no significant difference in the intervertebral height of L4, 5 and L, SI of groups A and B between pre- and post-operation （P 〉 0,05）. In group B, the intervertebral height of L, 4 was significantly reduced （P 〈 0.05） compared with the preoperative one. There was no significant difference in the ROM of Ls, S~ and ROM of lumbar in groups A and B between pre- and post-operation （P 〉 0.05）. At last follow-up, the ROM of L4, 5 was significantly reduced in group A （P 〈 0.05）, and the ROM of L3,4 was significantly increased in group B （P 〈 0.05）. Except significant differences in the intervertebral height and ROM of L3,4 between 2 groups （P 〈 0.05）, no significant difference was found in other parameters （P 〉 0.05）. Conclusion Posterior decompression combined with Coflex interspinous dynamic reconstruction has the same effectiveness as lumbar 360~ fusion in treating degenerative lumbar spinal disorders at L4, 5, but the former has a protective effect on the adjacent segments of fusion and is recommended for initial treatment of young adults and the elderly and frail patients with recurrent.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2011年第6期693-698,共6页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
腰椎退变性疾病
COFLEX
动力重建
后路减压
360°融合
Degenerative lumbar spinal disorder Coflex Dynamic reconstruction Posterior decompression 360° fusion
