摘要
腰椎间盘突出症、腰椎管狭窄症等腰椎退行性疾病是引起急性腰腿痛的主要原因,对于保守治疗失败的患者,融合内固定术是治疗该类疾病的主要方式,被称为"金标准"。Coflex为棘突间U形固定装置,是棘突间动态稳定系统的一种。区别于椎弓根螺钉融合内固定术,该装置既保留了手术节段一部分的活动度,又实现了手术节段的相对稳定。因此,Coflex动态稳定既可以缓解患者的临床症状,又能在一定程度上避免如手术节段活动度消失以及邻近节段退变等融合相关并发症的发生。对于多节段的腰椎退变,Topping-off术式即下位节段腰椎融合手术联合上位节段腰椎Coflex动态稳定展现了独特的优势,其在融合椎与正常椎之间起缓冲作用,避免了应力集中,可降低邻近节段椎间盘退变发生的风险。在临床应用过程中,Coflex动态稳定系统在设计细节以及应用途径等方面得到不断改进与拓展,新型的棘突间动态稳定系统IntraSPINE也取得了一定的临床疗效。近年来,关于Coflex的研究不断加深,Coflex系统的安全性和有效性不断被认可,但仍缺乏高级别大样本多中心的临床研究作为支撑。因此,旨在为Coflex系统的临床应用提供参考依据,本文就Coflex系统的适应证与禁忌证、生物力学特点、临床疗效、术后并发症及新型动态稳定装置的进展等方面进行综述。
Lumbar disc herniation,lumbar spinal stenosis and other interverbral degenerative diseases are the main causes of low back pain.For patients who have failed conservative treatment,fusion is the main way to treat this type of disease.Coflex is a kind of dynamic stabilization system between spinous processes.The device realizes the dynamic stability of the degenerative segment and retains the motion of lumbar spine.Compared with fusion,it cannot only relieve the clinical symptoms of patients,but also avoid the occurrence of fusion-related complications such as the disappearance of surgical segment mobility and the degeneration of adjacent segments.For multi-segment lumbar degeneration,the Topping-off procedure shows a unique advantage,which can reduce the risk of disc degeneration in adjacent segments.In recent years,research on Coflex has been deepened and the safety and effectiveness of the Coflex system have been continuously recognized,but there is still a lack of high-level,large-sample and multi-center clinical research as a support.Clinicians have continuously improved Coflex in their applications and developed new interspinous process dynamic stabilization devices.Therefore,in order to provide a reference for the clinical application of the Coflex system,this article reviews the indications and contraindications of the Coflex system,biomechanical characteristics,clinical efficacy,postoperative complications,and the development of new dynamic stabilization devices.
作者
杜明瑞
周程沛
魏飞龙
朱凯龙
钱济先
DU Ming-rui;ZHOU Cheng-pei;WEI Fei-long;ZHU Kai-long;QIAN Ji-xian(Department of Orthopaedic Surgery,the Second Affiliated Hospital of the Fourth Military Medical University,Xi'an,Shaanxi 710038,China)
出处
《中华全科医学》
2020年第9期1551-1554,共4页
Chinese Journal of General Practice
基金
国家自然科学基金(81871818)。
