单纯椎管扩大减压术与减压联合椎管成形术的临床疗效比较

Comparison of the clinical efficacy between simple vertebral canal decompression and decompression plus laminoplasty

目的:比较单纯椎管扩大减压、减压+羟基磷灰石/聚酰胺人工椎板重建以及减压+钛网椎板重建3种手术方式在治疗腰椎管狭窄症中的临床疗效。方法:回顾性分析腰椎管狭窄行手术治疗的39例患者,其中单纯椎板减压术组15例(A组)、减压+羟基磷灰石/聚酰胺人工椎板重建组14例(B组)、减压+钛网椎板重建组10例(C组),比较3组在手术情况、术后优良率及JOA评分等方面是否有差异。结果:A组手术时间、术中出血量明显小于B,C组(P<0.05),B与C组差异无统计学意义(P>0.05)。术后疗效评价:术后3个月3组比较差异无统计学意义(P>0.05);术后12个月,B与C组优良率明显高于A组(P<0.05)。JOA评分:术后3个月、12个月均高于术前(P<0.05);术后3个月3组间比较差异无统计学意义(P>0.05);术后12个月B,C两组高于A组(P<0.05)。3组均无重大并发症。术后影像学改变无明显差异。结论:单纯椎管扩大减压、减压+羟基磷灰石/聚酰胺人工椎板重建以及减压+钛网椎板重建3种术式均为治疗腰椎管狭窄症安全有效的手术方法,但后两者临床疗效优于前者。

Objective: To obser ve the clinical efficacy of the simple expansion of the spinal canal decompression, decompression plus hydroxyapatite/polyamide artificial lamina reconstruction, and decompression plus titanium mesh reconstruction in the treatment of spinal canal stenosi. Methods: A total of 39 patients with lumbar spinal stenosis(with or without disc herniation, spondylolisthesis less than I degree), who received therapy of surgery from January, 2011 to January, 2012, were retrospectively analyzed. All patients were divided into 3 groups: a laminectomy surgery alone group(group A, n=15), a decompression plus hydroxyapatite/polyamide artificial lamina reconstruction group(group B, n=14), and a laminectomy decompression plus reconstruction with titanium mesh group(group C, n=10). Intraoperative situation, the postoperative excellent rate and JOA score were analyzed. Results: The duration and blood loss in surgery in group A was much less than that in the group B and C(P<0.05), but there was no statistical significance between the group B and C. The postoperative excellent rate in three groups were similar in 3 months(P>0.05). Twelve months after the surgery, the group B and C showed advantage over the group A(P<0.05). JOA scores in 3 and 12 months after the surgery were all greater than that before the surgery(P<0.05). There was no difference in excellent rates in 3 groups in 3 months after the operation(P>0.05); the group B and C showed advantage over the group A in 12 months after the operation(P<0.05). No serious complications were related to the surgery in the 3 groups. Imaging changes were not significant difference. Conclusion: The decompression plus hydroxyapatite/polyamide artificial lamina reconstruction and the decompression plus titanium mesh reconstruction show advantages in long-term effect over the simple vertebral canal decompression.