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目的 评价棘突间动态稳定术治疗腰椎管狭窄症的长期临床疗效.方法 2007 年 9 月至2009 年 6 月,我院采用腰椎减压 ( 融合或无融合 ) 联合 Coflex 棘突间动态稳定手术治疗 30 例腰椎管狭窄症患者,其中男 12 例,女 18 例;年龄 46~77 岁,平均 ( 64.83±11.83 ) 岁.所有患者均完善临床和影像学评价.临床评估内容包括:术前、术后及末次随访时疼痛视觉模拟评分 ( visual analogue scale,VAS ),Owestry功能障碍指数 ( owestry disability index,ODI ),同时记录并发症,再手术率,邻近节段退变 ( adjacent segment degeneration,ASD ) 发生率.影像学评估包括:手术节段及其邻近节段椎间孔高度 ( intervertebral foraminal height,IFH ),椎间隙高度 ( intervertebral space height,ISH ) 和腰椎活动度 ( lumbar range of motion,ROM ).结果 本组 25 例行腰椎单节段减压 Coflex 棘突间动态稳定植入术 ( Coflex 组 ),5 例行腰椎后路减压椎间融合联合上位邻近节段 Coflex 动态稳定术 ( Topping-off 组 ).随访时间 84~108 个月,平均 94.6 个月.手术时间:Coflex 组 ( 76.5±12.6 ) min,Topping-off 组 ( 120.8±17.5 ) min;出血量:Coflex 组 ( 150.7±24.8 ) ml, Topping-off 组 ( 280.1±30.1 ) ml;住院日:Coflex 组 ( 10.8±1.9 ) 天,Topping-off 组 ( 12.5±1.5 ) 天,差异均有统计学意义 ( P0.05 ).末次随访时 Coflex 腰椎节段活动度由术前 ( 5.70±3.69 ) ° 下降至( 3.04±2.31 ) ° ( P=0.000 ),但其邻近节段椎间活动度无明显变化.3 例 ( 10% ) 出现 ASD,1 例出现 Coflex 节段再狭窄,1 例出现非邻近节段退变,其中 4 例 ( 13.3% ) 行二次手术治疗.4 例 ( 13.3% ) 出现 Coflex 假体周围棘突骨溶解,2 例 ( 6.7% ) 出现异位骨化.结论 Coflex 棘突间动态稳定术治疗腰椎管狭窄症的长期临床疗效肯定.其并发症发生率和再手术率较低.同时,Coflex 能够有效地维持手术节段 IFH 和 ISH,保留了椎间活动度,避免了邻近节段应力集中,能够有效地减少 ASD 的发生.“,”Objective To evaluate the long-term outcomes of the application of interspinous dynamic stabilization in lumbar spinal stenosis ( LSS ). Methods Thirty patients ( 12 males and 18 females, aged from 46 - 77, 64.83 ± 11.83 on average ) with the diagnosis of LSS, treated by Coflex interspinous dynamic stabilization in our clinic from September 2007 to June 2009, were involved in this study. Clinical evaluations including visual analogue score ( VAS ) and Owestry Disability Index ( ODI ) were performed. Complications, reoperation rate, adjacent segment degeneration ( ASD ) rate were recorded. Meanwhile, radiographic measurements including intervertebral foraminal height ( IFH ), intervertebral space height ( ISH ), lumbar range of motion ( ROM ) were compared pre-operation, post-operation, and at the last follow-up. Results Twenty-five Coflex surgeries, 5 Topping-off surgeries ( Coflex combined with fusion ) were completed successfully. The average follow-up period was 94.6 months ( range:84 - 108 months ). Operation time: Coflex ( 76.5 ± 12.6 ) min; Topping-off ( 120.8 ± 17.5 ) min. Blood loss: Coflex ( 150.7 ± 24.8 ) ml; Topping-off ( 280.1 ± 30.1 ) ml. Hospital stay: Coflex ( 10.8 ± 1.9 ) days; Topping-off ( 12.5 ± 1.5 ) days. Differences were statistically significant ( P 0.05 ). Range of motion ( ROM ) of the Coflex level had a slight drop from ( 5.70 ± 3.69 ) ° to ( 3.04 ± 2.31 ) ° ( P = 0.000 ), but the ROM of the adjacent segment was maintained. Three patients ( 10% ) presented ASD, 1 patient presented restenosis of the operated segment, and 1 patient presented degeneration on other segments, 4 ( 13.3% ) of them underwent the second surgery. Four patients ( 13.3% ) presented osteosynthesis of the spinous process around the Coflex. Two patients presented heterotopic ossification ( 6.7% ). Conclusions Coflex interspinous dynamic stabilization implanted after the decompression is long-term effective for LSS with acceptable complications and reoperation rate. Meanwhile, the Coflex could maintain the IFH, ISH and ROM of the operated level, which can effectively prevent the occurrence of ASD.