腰椎棘突间动态稳定系统治疗腰椎滑脱症的临床疗效

摘要

Objective To study the clinical results of Coflex and lumbar posterior decompression and fusion in the treatment of lumbar degenerative spondylolisthesis at L4-5.Methods Thirty-eight patients with Grade Ⅰ degenerative spondylolisthesis,from January 2008 to December 2011 in Beijing Chaoyang Hospital,Capital Medical University were reviewed,and patients were divided into two groups by randomness.Group A was treated with Coflex and group B with pedicle instrumentation and interbody fusion.Fifteen patients were included in group A,and 23 patients were included in group B.In group A,the average age was (56.3±9.1) years.In group B,the average age was (58.2± 11.2) years.The clinical results were evaluated by visual analogue scale (VAS) and Oswestry disability index (ODI).Slip distance (SD) was measured before and after surgery,and the changes of intervertebral angle at index level and adjacent level were also recorded.Results The follow-up period was 36 to 68 months,with the average of (39±14) months in the both groups.The operation time and bleeding volume of patients in group A were significantly less than that of group B (P＜0.05).In both groups,the difference of ODI and VAS before operation and postoperative follow-up were statistically significant (P ＜ 0.05).There was no significant difference between lumbar intervertebral angle and the sliding distance in group A at all time points.In the group B,there was a significant increase in the intervertebral angle and the sliding distance at L3-4 and L5-S1 level after surgery,the difference at upper and below adjacent segment before and after surgery were statistically significant.Conclusions Coflex interspinous dynamic stabilization system has same excellent clinical results as pedicle screw instrumentation and fusion surgery for the treatment of L4-5 degenerative spondylolisthesis;no significant progression of spondylolisthesis been observed during more than 3 years follow-up,and no obvious adjacent segment degeneration has been found.%目的 探讨腰椎棘突间动态稳定系统(Coflex)治疗Ⅰ度腰椎退变性滑脱的手术疗效.方法 对2008年1月至2011年12月首都医科大学附属北京朝阳医院收治的38例L4～L5Ⅰ度退变性滑脱症患者进行回顾性分析.依据手术方法的不同,将患者分为椎板间开窗减压+Coflex棘突间动态内固定组(A组)和腰椎后路减压椎弓根钉固定椎间植骨融合组(B组).其中A组15例,年龄42 ～ 75岁,平均(56.3±9.1)岁;B组23例,年龄45 ～ 77岁,平均(58.2±11.2)岁.采用疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)评定临床疗效.测量术前、术后手术节段及相邻节段椎间角变化,手术节段和相邻节段矢状位滑脱距离(SD).采用SPSS 19.0统计学软件对两组患者术前、术后1年及末次随访时的VAS、ODI、手术节段和邻近节段的椎间角、手术节段矢状位SD等数据进行配对t检验.结果 两组患者随访时间为36～ 68个月,平均随访(39±14)个月.A组患者手术时间、出血量均少于B组(分别为t=2.11、t=2.32,P＜0.05).VAS评分:与术前相比,两组患者术后1年及末次随访时VAS腰痛评分均明显减小,差异有统计学意义(A组分别为t=2.85、t=2.93,B组分别为t=2.78、t=2.82,P值均＜0.05);两组患者术后1年及末次随访时VAS腿痛评分均明显减小,差异有统计学意义(A组分别为t=2.91、t=2.97,B组分别为t=2.86、t=2.91,P值均＜0.05).ODI评分:与术前相比,两组患者术后1年及末次随访时均较术前明显减小,差异有统计学意义(A组分别为t=2.34、t=2.53,B组分别为t=2.44、t=2.51,P值均＜0.05);两组之间各个时间点VAS评分、ODI评分的差异无统计学意义(P＞0.05).椎间角:A组患者L4～L5术后1年及末次随访时与术前对比,差异有统计学意义(分别为t=2.11、t=2.19,P＜0.05);B组患者术后1年及末次随访时与术前相比,椎间角差异有统计学意义(L3～ L4分别为t=2.15、t=2.33,L5～S1分别为t=2.25、t=2.34,P值均＜0.05),术前L3～L4、L5～ S1与A组的差异无统计学意义(P＞0.05).SD:A组L4～L5术后1年及末次随访时与术前相比,差异均无统计学意义(P值均＞0.05);B组术后1年和末次随访时与术前相比明显减小,差异有统计学意义(L4～L5分别为t=2.37、t=2.59,L3～L4分别为t=2.44、t=2.61,L5～S1分别为t=2.43、t=2.54,P值均＜0.05).结论 Coflex治疗L4～L5Ⅰ度退变性滑脱疗效优良,术后3年以上的随访未发现明显的滑脱进展,相邻节段无明显退变加重.