摘要
目的:探讨椎板开窗减压Coflex棘突间撑开装置动态固定治疗中度腰椎管狭窄症的疗效。方法:2007年10月至2008年7月,采用椎板开窗减压后Coflex棘突间撑开装置动态固定治疗32例中度腰椎管狭窄症患者,均为L4/5节段。男14例,女18例,年龄38～60岁,平均47岁。对患者术前、术后及不同随访时间分别摄腰椎正侧位及动力位X线片,测量手术间隙椎间隙前、后缘高度,椎间孔高度及活动范围,同时对患者进行Os-westry功能障碍指数(ODI)和疼痛视觉模拟评分(VAS)评定。结果:术后随访19～30个月,平均25个月,术后3个月、1年及末次随访时的ODI及VAS均较术前有明显下降(P<0.05),末次随访较术后3个月和1年继续下降,差异有显著性(P<0.05);椎间隙后缘高度及椎间孔高度较术前增加(P<0.05),但随着随访时间的延长,高度有下降,椎间隙前缘高度与术前比较略有下降,但无统计学意义;手术节段保持一定活动度,但较术前明显下降(P<0.05)。结论:椎板开窗减压后应用Coflex棘突间撑开装置动态固定治疗中度腰椎管狭窄症的近中期疗效满意,能较好地维持手术节段椎间隙及椎间孔高度,减少手术节段活动度,预防椎间隙塌陷及腰椎不稳,远期疗效尚需更长期的随访。
Objective：To evaluate the short to midterm clinical and radiological results of interspinous dynamic stabilization（Coflex） after decompression in treatment of patients for moderate lumbar spinal stenosis. Method：In this retrospective study,all patients （n=32） with level L4/5 involved from Octobor 2007 to July 2008 were collected.There were 14 males and 18 females with the mean age of 47 years（range,38-60 years）. VAS and ODI were used to evaluate the pain status and lumbar function,lumbar anteroposterior,lateral and flexion-extension X-ray films preoperatively,and at follow-up were used to measure the following parameters： the anterior and posterior disc space height,foraminal height,the range of motion at surgical level.Result：All patients were followed up for an average of 25 months（range,19-30 months）.The postoperative VAS and ODI score decreased significantly （P 0.001） compared with preoperative counterparts.The posterior disc space height and foraminal height increased significantly up to 1 year after operation,which had the tendency of decreaseing with time progressing.The anterior disc space height did not change significantly while the range of motion at surgical level decreased through the entire follow-up.Conclusion：Interspinous dynamic stabilization termed as Coflex after decompressive laminectomy can maintain disc height and foraminal height, which is aimed to decrease the ROM of surgical level as well as avoid instability,its mid-term efficacy is reliable,however its long-term outcome needs to be further investigated.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
北大核心
2010年第10期834-838,共5页
Chinese Journal of Spine and Spinal Cord
关键词
腰椎管狭窄症
棘突
动态固定
非融合术
Lumbar spinal stenosis Spinous process Dynamic stabilization Nonfusion
