摘要
背景:传统的腰椎融合内固定治疗会带来各种术后并发症,因此非融合技术在临床应用日益广泛,棘突间撑开装置Coflex便是其中一员,其与传统腰椎融合内固定技术相比具有独特的生物力学优势,随着Coflex假体不断改进与完善,其在未来将具有广阔的应用前景。目的:对Coflex治疗腰椎管狭窄的临床效果、生物力学、有限元分析、并发症及最新发展等方面进行阐述。方法:第一作者以"腰椎,生物力学,腰椎管狭窄症,Coflex,有限元分析"检索CNKI数据库、万方数据库、Sinomed数据库,以"Lumbar spine,Biomechanics,Lumbar spinal stenosis,Coflex,Finite element analysis"检索PubMed数据库、SpringerLink数据库、Science Citation Index-Expanded(SCIE)数据库、中国科学引文索引数据库(CSCI)、IEEE Xplore Digital Library数据库2005至2018年出版的文献。纳入有关Coflex治疗退行性腰椎管狭窄症的临床调查、生物力学分析及有限元分析的相关文献,排除重复研究。通过阅读摘要初步筛选,共选取34篇文献进行综述,其中中文9篇,英文25篇。结果与结论:①Coflex棘突间动态装置与同类型棘突间装置治疗效果类似,相对于传统腰椎融合内固定甚至具有一定优势,手术创伤小,时间短,术后恢复快、而且保留了手术节段活动性,延缓了邻近节段退变,在一定程度上可防止临椎病的发生;②就生物力学而言,Coflex保留了责任节段的部分活动,减少了责任节段椎间盘和关节突的负荷,间接增大了椎间孔的高度,缓解了临床症状;③三维有限元分析通过计算机应力云图分析显示,Coflex置入后对责任节段椎间盘、小关节等有明显分担负荷作用,同时可以显示保留邻近节段的活动度位移,减少临近节段的椎间盘及小关节应力,而且有限元分析可以模拟不同体内力学环境,分析Coflex置入前后不同研究对象、不同活动方式、不同承载负荷单元的力学分布变化,是一种可重复、行之有效方法和手段,但有限元分析仅仅模拟局部力学,范围较局限,且易出现掩盖Coflex真实并发症等问题;④Coflex易出现内固定松动、棘突骨折、退行性疾病复发、异位骨化等并发症,导致再次手术治疗。目前Coflex的使用没有标准规范,适用范围尚未确切统一,因此Coflex的临床应用仍然有待进一步探索。
BACKGROUND: Traditional lumbar fusion and internal fixation technology brings various postoperative complications;therefore, non-fusion technology is increasingly used in clinical practice. Interspinous process device Coflex has unique biomechanical advantage compared with conventional lumbar fusion and internal fixation technology. With the continuous improvement of Coflex prosthesis, it will have a bright prospect in the future. OBJECTIVE: To review the clinical effect, biomechanics, finite element analysis, complications and latest advances of Coflex in the treatment of lumbar spinal stenosis. METHODS: CNKI, WanFang, Sinomed, PubMed, SpringerLink, SCIE, CSCI and IEEE Xplore Digital Library databases between 2005 and 2018 were retrieved using the keywords of “lumbar spine, biomechanics, lumbar spinal stenosis, Coflex, finite element analysis” in Chinese and English, respectively. The studies on clinical investigation, biomechanical analysis and finite element analysis of Coflex in the treatment of degenerative lumbar spinal stenosis were included, and repeated studies were excluded. Finally 34 eligible articles were selected for review by reading the abstract, including 9 Chinese and 25 English articles. RESULTS AND CONCLUSION:(1) The effect of Coflex interspinous dynamic device is similar to the same type of interspinous device. Coflex has certain advantages compared with traditional lumbar fusion and internal fixation technology, which has little trauma, short time, rapid recovery, preserves the activity of the surgical segments and can delay the degeneration of adjacent segments and reduces the occurrence of vertebral disease to some extent.(2) In terms of biomechanics, Coflex can retain the activity of the responsible segments, reduce the load on the disc and the facet of the responsible segments, indirectly increase the height of the intervertebral foramen, and alleviate the clinical symptoms.(3) Stress nephogram of three-dimensional finite element analysis shows that Coflex has a significant load-bearing effect on the discs and facets of the responsible segments, and can reduce the intervertebral disc and small joint stress of adjacent segments. Finite element analysis can simulate different in vivo mechanical environments, analyze the changes of mechanical distribution in different research objects, activities and load-bearing units before and after Coflex placement. It is a reproducible and effective method, but the finite element analysis only simulates local mechanics. Its scope is limited, and it is easy to cover the real complications of Coflex.(4) Coflex will cause complications such as internal fixation loosening, spinous process fractures, recurrence of degenerative diseases, and heterotopic ossification, leading to secondary surgery. There is no specific standard for the use of Coflex, and the application scope has not been completely unified. Therefore, the clinical application of Coflex still needs further exploration.
作者
肖永川
梁川东
许泽川
李育刚
常山
Xiao Yongchuan;Liang Chuandong;Xu Zechuan;Li Yugang;Chang Shan(the First Affiliated Hospital of Chengdu Medical University, Chengdu 610000, Sichuan Province, China)
出处
《中国组织工程研究》
CAS
北大核心
2019年第24期3862-3867,共6页
Chinese Journal of Tissue Engineering Research
关键词
腰椎
生物力学
腰椎管狭窄症
棘突间撑开装置
COFLEX
有限元分析
并发症
lumbar vertebrae
biomechanics
lumbar spinal stenosis
interspinous process device
Coflex
finite element analysis
complications
