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单纯髓核摘除术与髓核摘除辅助Coflex动态固定术治疗腰椎间盘突出症的疗效对比研究

Discectomy and discectomy plus Coflex fixation for lumbar disc herniation,a clinical comparison study

摘要:

目的 通过单纯髓核摘除术与加用Coflex棘突间动态稳定系统治疗腰椎间盘突出症的疗效对比研究,评价Coflex在治疗腰椎间盘突出症中的应用价值.方法 2007年11月至2008年8月分别采用单纯髓核摘除术与加用Coflex棘突间动态稳定系统治疗腰椎间盘突出症50例,男性31例,女性19例;年龄30 ~72岁,平均52.5岁.病史6~48个月,平均15.6个月.其中单纯髓核摘除组26例,Coflex固定组24例.通过视觉模拟量表(VAS)评分、日本骨科协会(JOA)评分、Oswestry功能障碍指数(ODI)评分和影像学分析,采用配对t检验及单向方差分析,评价Coflex动态稳定系统在治疗腰椎间盘突出症中的价值.结果 单纯髓核摘除组与Coflex固定组在JOA、ODI、VAS评分上较术前均有显著改善(t=-33.2~64.5,P<0.01),但单纯髓核摘除术组末次随访ODI评分显著增加,由术后12个月的6.7±1.5增加到10.2±2.3(t=-19.3,P<0.05).影像学显示Coflex固定组手术前后手术节段椎间盘背侧高度(HD)、椎间孔间最大距离(DIF)、棘突顶距(DS)及椎管面积(SA)均明显增加(t=-34.4~4.5,P<0.05).单纯髓核摘除术组上述指标则显著减小(t=3.4 ~52.8,P <0.05).Coflex固定组在HD、DIF、DS上均高于单纯髓核摘除组,差异具有统计学意义(F=14.1~25.6,P<0.05).结论 腰椎间盘突出单纯髓核摘除术与加用Coflex治疗腰椎间盘突出症均有显著疗效,但Coflex固定组确实增加了椎间盘背侧高度和椎间孔间最大距离,在近中期疗效、防止腰椎退变方面明显优于单纯髓核摘除组.

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abstracts:

Objective To compare clinical efficacy between discectomy and discectomy plus Coflex fixation for lumbar disc herniation.Methods From December 2007 to August 2008,50 patients(31 males and 19 females)were treated by surgery of discectomy and discectomy plus Coflex fixation.The average age was 52.5 years(range,30-72 years).There were 24 cases in the group of discectomy plus Coflex fixation and 26 cases in the group of discectomy.Preoperative and postoperative visual analogue scales(VAS),Japanese Orthopadic Association(JOA)and Oswestry disability index(ODI)were recorded,as well as radiological index.And use a paired t-test and one-way analysis of variance(one-way ANOVA)statistical method to evaluate the Coflex dynamic stabilization system in value in the treatment of lumbar disc herniation.Results Both groups received significant improvement of JOA,ODI and VAS(t =-33.2-64.5,P < 0.01),but the group of discectomy was found with deterioration of ODI at last follow-up,12 months after surgery 6.7 ± 1.5 to 10.2 ± 2.3(t =-19.3,P < 0.05).The group of discectomy plus Coflex fixation was found with significant increase of height of dorsal intervertebral discs(HD),distance across the two adjacent spinous processes(DS),distance of intervertebral foramina(DIF)and spinal canal area(SA)(t =-34.4-4.5,P < 0.05).In contrast,the group of discectomy was found with significant decrease of HD,DS,DIF and SA(t =3.4-52.8,P <0.05).Coflex fixed group in HD,DIF,DS significant difference with simple discectomy group,with a statistically significant(F =14.1-25.6,P < 0.05).Conclusions Both discectomy and discectomy plus Coflex fixation are apparently effective when treating lumbar disc herniation.Coflex can significantly increase the HD and DIF when used for lumbar disc herniation,and it has positive influence for keeping height of lumbar vertebral space and treating the nerve root symptom of lumbar disc herniation.Discectomy plus Coflex is better than pure discectomy in preventing lumbar degeneration.

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