摘要目的 探讨棘突间Coflex动态内固定系统治疗腰椎退行性疾病的影像学变化.方法 对2010年1月至2013年12月首都医科大学附属北京朝阳医院骨科采用棘突间Coflex动态内固定治疗的腰椎管狭窄症病例进行随访分析.60例腰椎管狭窄症患者纳入研究,其中男性34例,女性26例,平均年龄59.4岁;单纯Coflex固定33例,Topping-off手术27例;Coflex手术节段:L1～21例,L2～35例,L3～419例,L4～535例.测量Coflex手术节段及上下邻近节段术前、术后及随访时患者的腰椎椎间孔高度、宽度、椎间隙高度及腰椎前凸角.同时,评价患者术前、术后及随访时Oswestry功能障碍指数(ODI)评分及疼痛视觉模拟量表(VAS)评分.本研究计量数据采用(x)±s表示,术前、术后及随访数据进行配对样本t检验,并对Coflex组与Topping-off组进行独立样本t检验.结果 手术节段的椎间孔高度(FH):术前为(19.82±2.38)mm,术后1个月为(22.28±2.95)mm(与术前相比P＜0.05),末次随访时为(19.31±3.32)mm(与术前相比P＞0.05);椎间孔宽度(FW):术前为(11.2±2.02) mm,术后1个月为(11.58±2.13)mm(与术前相比P＞0.05),末次随访时为(11.12±2.21)mm(与术前相比P ＞0.05);椎间隙高度(ISH):术前为(7.84±1.56)mm,术后1个月为(10.05±2.39)mm(与术前相比P＜0.05),末次随访时为(7.91±1.77)mm(与术前相比P＞0.05).末次随访时,FH和ISH的丢失程度与手术上、下邻近节段相比P＞0.05.腰椎前凸角(LL):术前为43.13.±15.93.,术后1个月为38.41°±10.82°(与术前相比P＜0.05),末次随访时为43.10°±13.21°(与术前相比P ＞0.05).60例患者均获得良好临床疗效,术前ODI评分为(65.12±13.56)分,末次随访时为(9.89±1.77)分;术前VAS评分为(8.02±1.81)分,末次随访时为(1.66±0.51)分.结论 棘突间Coflex动态内固定手术能够短期增加FH和ISH,但不能长期维持FH和ISH.棘突间Coflex动态内固定手术对于腰椎管狭窄症患者临床症状的改善主要得益于术中的有效减压.

abstractsObjective To assess the radiography change of lumbar spinal stenosis (LSS) treated with the implantation of Coflex interspinous device retrospectively.Methods Sixty patients (34 male and 26 female) with LSS who underwent the decompression and Coflex device implanted surgery from January 2010 to December 2013 were followed up.The mean age of the patients was 59.4 years.There were 33 cases underwent Coflex surgery and 27 cases underwent Topping-off surgery.The Coflex segment ranged from L1/2 to L4/5 (L1-2:1,L2_3:5,L3_4:19,L4_5:35).The foraminal height,foraminal width and intervertebral space height change of the Coflex segment as well as its adjacent segment were recorded pre-/post-operatively and at last follow-up.Meanwhile,the Oswestry Disability Index (ODI) and Visual Analog Scale(VAS) were measured in all patient pre-/post-operatively and at last follow-up.The measurement data was recorded as ~ ± s.And the independent and paired samples t-test was used to conduct the statistical analysis.Results The foraminal height(FH) increased from (19.82 ± 2.38) mm to (22.28 ± 2.95) mm (P ＜ 0.05) post-operatively,and the FH decreased to (19.31 ± 3.32) mm at the last follow up(P ＞ 0.05,compared to the post-operation).The average foraminal width (FW) was 11.2 mm,11.58 mm and 11.12 mm at pre-/post-operation and follow up,which had no significant different change(P ＞0.05).The post-operative intervertebral space height (ISH) increased from (7.84 ± 1.56) mm to (10.05 ±2.39) mm (P ＜0.05),and the ISH decreased to (7.91 ± 1.77) mm at the last follow up(P ＞0.05,compared to the post-operation).The amount of the decreased FH and ISH had no significant difference when comparing the Coflex segment with its adjacent (Coflex ± 1) segments (P ＞ 0.05).The lumbar lordosis (LL) was 43.13° ± 15.93°,38.41° ± 10.82° and 43.10° ± 13.21° at pre-/post-operation and follow up,there was no significant difference between pre-and post-operation (P ＞ 0.05).All patients showed statistically significant improvement(P ＜ 0.05) in the clinical outcome assessed in the VAS and ODI at the time of follow up compared to the pre-operation.The ODI score decreased from 65.12 ± 13.56 to 9.89 ± 1.77; the VAS score decreased from 8.02 ± 1.81 to 1.66 ± 0.51.Conclusions Coflex device could temporarily improve the FH and ISH after operation.However,it could not maintain the improvement as the follow-up time extended.The surgical decompression is the responsible factor for the good clinical outcome but not the improvement of FH.