摘要目的 总结Coflex动态固定术治疗腰椎退变性疾病的中期临床疗效.方法 回顾性分析2008年10月至2010年12月采用Coflex动态固定术治疗并获得1年以上随访的39例腰椎退变性疾病患者资料,其中男性29例,女性10例；年龄23～67岁,平均45.5岁.以腰椎日本骨科协会(JOA)评分、Oswestry功能障碍指数(ODI)评分、疼痛视觉模拟量表(VAS)评分及SF-36生活质量评分为主观症状评价指标,以手术节段及其邻近节段的椎间隙高度、活动度为影像学评价指标,通过配对t检验及单因素方差分析比较各组患者的治疗效果及不同体重指数及年龄段人群的疗效差异.结果 患者随访12～37个月,平均30.9个月.末次随访时,JOA、ODI、VAS及SF-36评分均较术前改善,差异有统计学意义(t=-33.289、26.448、26.596和-20.772,P=0.000)；改善率分别为70％±12％、54％±12％、77％±10％及51％ ±9％；同时,体重指数≥25 kg/m2的患者各评分改善率均低于体重指数＜ 25 kg/m2的患者,差异有统计学意义(F=10.561、5.850、5.651和6.519,P ＜0.05)；年龄≥50的患者与年龄＜50的患者各评分改善率差异无统计学意义(P＞0.05).影像指标上,除L4～5椎间隙高度较术前增高外(t=-2.819,P=0.008),其余各椎间隙高度变化差异均无统计学意义(P＞0.05)；单节段病变患者中,除L4～5节段活动度降低外(t=12.598,P=0.000),L3～4、L5～S1及L1～S1节段活动度均无明显变化(P＞0.05).结论 Coflex棘突间动态稳定系统治疗腰椎退变性疾病中期疗效确切,Coflex联合Isobar非融合内固定治疗多节段腰椎退变性疾病具有一定优势.

abstractsObjective To summarize the mid-term effectiveness of Coflex non-fusion internal fixation treatment of degenerative lumbar disease.Methods From October 2008 to December 2010,a retrospective analysis was carried out on 39 patients(29 males and 10 females)diagnosed as degenerative lumbar disease and treated with Coflex interspinous dynamic device,who had been followed up for 1 year at least,the average age was 45.5 years(range,23-67 years).The results were assessed by Japanese Orthopedic Association(JOA)scores,visual analogue scale(VAS)scores,Oswestry disability index(ODI)scores and SF-36 scores;and the range of mobility(ROM),intervertebral disc height of the responsible and adjacent segments were measured on X-film before the operation and at last follow-up.Observed the therapeutic effect of the patients and compared the effect on the patients of different body mass index(BMI)and different age by the One-way analysis of variance and paired t test.Results The 39 patients were followed up for 30.9 months(range,12-37 months).At the last follow-up,JOA,ODI,VAS and SF-36 scores were improved by 70％ ± 12％,54％ ± 12％,77％ ± 10％ and 51％ ±9％,and were statistically significant(t =-33.289,26.448,26.596 and-20.772,P =0.00).Patients with BMI ≥ 25 kg/m2 had lower improvement rates in the scores than those with BMI ＜ 25 kg/m2(F =10.561,5.850,5.651 and 6.519,P ＜0.05).The patients were 50 years older or younger couldn't affected the improvement rates in the scores statistically(P ＞ 0.05).There were no significant difference in remaining disc height(P ＞ 0.05),except that the intervertebral disc height of L4-5 increased slightly compared with the preoperative (t =-2.819,P =0.008).In addition to the ROM of L3-4,L5-S1 and L1-S1 were not significantly different from the preoperative(P ＞0.05),the ROM of L4-5 were decreased(t =12.598,P =0.000).Conclusions The mid-term effectiveness of Coflex non-fusion interspinous fixation in treatment of degenerative lumbar disease is worthy of recognition,and Coflex combined with Isobar has advantages in the treatment of multisegment degenerative lumbar disease.