Yao Yicun, Ye Dongping, Liang Weiguo, Miao Haixiong, Wu Jinfeng, Zhou Ziqiang
Department of Orthopedics, Guangzhou Red Cross Hospital, Guangzhou Red Cross Hospital Affiliated to Jinan University, Guangzhou Guangdong, 510220, P.R.China.
Department of Orthopedics, Guangzhou Red Cross Hospital, Guangzhou Red Cross Hospital Affiliated to Jinan University, Guangzhou Guangdong, 510220,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2019 Mar 15;33(3):280-286. doi: 10.7507/1002-1892.201807099.
To evaluate the effectiveness of Coflex interspinous dynamic internal fixation combined with spinal fusion for lumbar disc degeneration.
The clinical data of 39 patients with two-level lumbar disc degeneration who met the selection criteria between June 2010 and December 2011 was retrospectively analyzed. They were divided into group A (20 cases, simple lumbar decompression and fusion) and group B (19 cases, Coflex interspinous dynamic internal fixation combined with spinal fusion) according to different surgical methods. There was no significant difference in age, gender, disease diagnosis, lesion segment, disease duration, Oswestry disability index (ODI), visual analogue scale (VAS) score, and the intervertebral height, foramen intervertebral height (FIH), and range of motion (ROM) of upper operative segment and adjacent segment between the two groups ( >0.05). ODI and VAS score were used to evaluate the effectiveness before operation and at last follow-up, and the improvement rates were calculated. The intervertebral height [anterior disc height (ADH), middle disc height (MDH), and posterior disc height (PDH)], FIH, and ROM were measured and compared between the two groups.
The operation time and intraoperative blood loss in group A were significantly more than those in group B ( <0.05), and there was no significant difference in hospitalization time between the two groups ( =0.992, =0.328). All patients were followed up; the follow-up time was 33-50 months (mean, 40.5 months) in group A and 39-51 months (mean, 42.6 months) in group B. No complication such as displacement, loosening, or rupture of internal fixator was found in both groups. At last follow-up, ODI and VAS score of the two groups significantly improved when compared with preoperative scores ( <0.05). At last follow-up, there was no significant difference in ODI, VAS score, and improvement rate of ODI between the two groups ( >0.05); the improvement rate of VAS score in group B was significantly higher than that in group A ( =2.245, =0.031). There was no significant difference in the intervertebral height and FIH of the upper operative segment at last follow-up between the two groups and between preoperation and last follow-up in the two groups ( >0.05). At last follow-up, the ADH of adjacent segment in group B was significantly higher than that in group A, and MDH, PDH, and FIH were significantly lower than those in group A ( <0.05). Compared with preoperation, the ADH of adjacent segment in group A decreased and MDH, PDH, and FIH increased at last follow-up ( <0.05), while all indexes in group B did not change significantly ( >0.05). The ROM of adjacent segment in group A increased significantly at last follow-up ( =2.318, =0.026). There was significant difference in ROM of adjacent segment between the two groups ( <0.05).
The mid-term effectiveness of Coflex interspinous dynamic internal fixation combined with spinal fusion is similar to that of simple decompression fusion. For those patients whose adjacent segments of the responsible segments have degeneration but have no symptoms or mild symptoms, this treatment can slow down the adjacent segment degeneration.
评估Coflex棘突间动态内固定联合脊柱融合术治疗腰椎间盘退变的有效性。
回顾性分析2010年6月至2011年12月间39例符合入选标准的双节段腰椎间盘退变患者的临床资料。根据手术方式不同将其分为A组（20例，单纯腰椎减压融合术）和B组（19例，Coflex棘突间动态内固定联合脊柱融合术）。两组患者在年龄、性别、疾病诊断、病变节段、病程、Oswestry功能障碍指数（ODI）、视觉模拟评分（VAS）、上位手术节段及相邻节段的椎间隙高度、椎间孔高度（FIH）和活动度（ROM）等方面比较，差异均无统计学意义（>0.05）。采用ODI和VAS评分评估术前及末次随访时的疗效，并计算改善率。测量并比较两组患者的椎间隙高度[椎间盘前缘高度（ADH）、椎间盘中部高度（MDH）和椎间盘后缘高度（PDH）]、FIH及ROM。
A组手术时间和术中出血量显著多于B组（<0.05），两组住院时间比较差异无统计学意义（=0.992，=0.328）。所有患者均获随访，A组随访时间为3350个月（平均40.5个月），B组为3951个月（平均42.6个月）。两组均未发现内固定物移位、松动或断裂等并发症。末次随访时，两组ODI和VAS评分较术前均显著改善（<0.05）。末次随访时，两组ODI、VAS评分及ODI改善率比较，差异无统计学意义（>0.05）；B组VAS评分改善率显著高于A组（=2.245，=0.031）。末次随访时，两组上位手术节段的椎间隙高度和FIH比较，以及两组术前与末次随访比较，差异均无统计学意义（>0.05）。末次随访时，B组相邻节段ADH显著高于A组，MDH、PDH和FIH显著低于A组（<0.05）。与术前比较，A组末次随访时相邻节段ADH降低，MDH、PDH和FIH升高（<0.05），而B组各指标变化均无统计学意义（>0.05）。A组末次随访时相邻节段ROM显著增加（=2.318，=0.026）。两组相邻节段ROM比较差异有统计学意义（<0.05）。
Coflex棘突间动态内固定联合脊柱融合术的中期疗效与单纯减压融合术相似。对于责任节段相邻节段已发生退变但无症状或症状较轻的患者，该治疗可减缓相邻节段退变。
