摘要
目的 探讨经后路单侧椎板入路双侧减压椎间隙植骨融合内固定改良术治疗单侧症状为主的退变性腰椎管狭窄症的临床疗效.方法 回顾性分析2013年1月至2014年12月亳州市人民医院脊柱外科40例单侧症状为主的腰椎管狭窄症患者,其中A组（20例）患者均采用经症状较重侧下关节突、上关节突部分、椎板切除减压、对侧侧隐窝减压、椎间融合椎弓根螺钉内固定的改良术式治疗,B组（20例）均采用全椎板切除、椎间融合椎弓根螺钉内固定术.记录两组患者的手术时间、术中出血量;手术前,手术后3、6、12个月视觉模拟评分法（VAS）、欧式功能障碍指数（ODI）、术后日本骨科协会评分（JOA）和影像学植骨融合检查结果,对比评价手术效果.结果 手术前A组VAS、ODI、JOA与B组比较差异无统计学意义（P＞0.05）.术中出血量、手术时间A组分别为（415.0±42.1） ml、（133.2±25.3） min,与B组比较差异有统计学意义[（491.0±46.3）ml;（156.2 ±28.5）min,P＜0.05）];术后3、6个月两组VAS、ODI、JOA比较差异无统计学意义（P＞0.05）;术后12个月A组VAS评分为（3.0±0.6）分、JOA评分为（25.3±5.1）分、ODI评分为（16.5±1.5）分,与B组比较差异有统计学意义（P＜0.05）;术后12个月影像学资料显示A组椎间植骨融合率100％、B组95％,两组比较差异有统计学意义（P＜0.05）.结论 对于单侧严重狭窄且症状较重,对侧椎管或侧隐窝轻、中度狭窄且症状较轻的腰椎管狭窄症患者,单侧入路双侧减压椎间隙植骨融合内固定术手术时间和术中出血量更少,疗效更满意,腰椎术后稳定性更好.
Objectives To compare the efficacy between unilateral laminectomy approach bilateral decompression and traditional total laminectomy decompression in the treatment of graft bone fusion and internal fixation for degenerative lumbar spinal stenosis with the unilateral symptoms.Method From January 2013 to December 2014,a total of 40 patients with unilateral symptoms of lumbar spinal stenosis were treated in Department of Spinal Surgery Bozhou People＇s Hospital of Anhui Province.Twenty patients （group A） were treated by severe symptoms unilateral facetectomy and resection of superior articular and laminectomy and lateral recess decompression,interbody fusion,pedicle screw fixation.Twenty patients （group B） were treated by total laminectomy interbody fusion and pedicle screw fixation.The time of operation,blood loss of the two groups were recorded.At the same time the visual analog scale （VAS）,Oswestry disability index（ODI）,Japanese Orthopaedic Association Scores （JOA） before and after operation （3,6,12months） were recorded retrospectively.The effect of surgery were evaluated and compared.Result The VAS,JOA,and ODI of group A preoperation is respectively have no significant differences with the group B （P 〉 0.05）.The operation time,blood loss in operation of group A was respectively （133.2 ± 25.3） min,（415.0 ± 42.1） ml,significant differences with the group B [（491.0 ± 46.3） ml;（156.2 ± 28.5） min,P 〈 0.05）].The VAS,JOA,ODI of group A had no significant differences with the group B （P 〉 0.05） at 3,6 months after operation.The VAS,JOA,ODI of group A was respectively （3.0 ± 0.6）,（25.3 ± 5.1）,（16.5 ± 1.5）scores,had significant differences with the group B and preoperation （P 〈 0.05） at 12 months after operation.The radiographic data showed that the interbody fusion rate of group A was 100%,and group B was 95%,had significant differences by statistical analysis （P 〈 0.05） at 12 months afer operation.Conclusion The improved unilateral laminectomy approach and bilateral decompression have less operation time and blood loss,more satisfactory for the lumbar spinal stenosis patients with the unilateral severe symptoms,the other side moderate stenosis and mild symptoms.The efficacy of lumbar stability and bilateral decompression is better by operation of improved unilateral approach.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2016年第21期1673-1676,共4页
National Medical Journal of China
关键词
椎管狭窄
腰症
减压术
外科
Spinal stenosis
Lumbar vertebrae
Decompression,surgical
