棘突纵切入路椎管减压术治疗腰椎管狭窄症

Lumbar spinous process-splitting laminectomy for the treatment of lumbar canal stenosis

目的:评价棘突纵切入路椎管减压术(lumbar spinous process-splitting laminectomy,LSPSL)治疗腰椎管狭窄症(lumbar canal stenosis,LCS)的临床效果。方法:2006年4月～2007年2月在我院接受手术治疗的LCS患者77例,31例患者采用LSPSL,另46例采用传统入路椎管减压。两组患者均随访1年,采用JOA评分进行临床效果评价,通过手术前后MRIT2像上L4/5和L5/S1椎间隙水平椎旁肌面积的改变评定椎旁肌肉的损伤程度。结果:LSPSL组手术时间为140±35min,传统入路组为125±25min,两组比较无显著性差异(P>0.05);LSPSL组出血量为120±32ml,较传统入路组的180±27ml明显减少(P<0.05)。两组患者术后1年时的JOA评分较术前显著提高(P<0.01),LSPSL组JOA评分改善率为62%±3%,显著高于传统入路组的43%±7%(P<0.01)。术后1年时LSPSL组L4/5和L5/S1椎间隙水平椎旁肌萎缩率为6.4%、6.9%,明显低于传统入路组的31%、30%(均P<0.001)。LSPSL组2例术后出现伤口周围痛,术后40d内逐步缓解;传统入路组5例术后出现腰椎失稳并伴腰痛,需长期口服小剂量非甾体抗炎镇痛药物治疗。结论:棘突纵切入路椎管减压术操作并不复杂,而且和传统入路一样可以完成腰椎管充分减压,同时可以明显降低腰椎后路手术对于椎旁肌肉的损伤,提高疗效,减少手术后腰痛的发生。

Objective：To evaluate the validity and short-term results of lumbar spinous process-splitting laminectomy （LSPSL） for the treatment of lumbar canal stenosis （LCS）.Method： From April 2006 to February 2007,all cases with LCS were retrospectively studied,of which 31 cases were treated by LSPSL,46 cases underwent the laminectomy through conventional approach.All patients in both groups were followed up one year. The clinical results were evaluated by Japanese Orthopaedic Association （JOA） scores and the extent of sacrospinalis atrophy was measured through pre- and post-operative MRI of T2 images at IA/5 and LS/S1 levels in both groups.Result：Compared with the conventional approach,LSPSL had lower blood loss（120±32ml vs 180±27ml,P〈0.05）,operation time was nearly the same （140±35min vs 125±25min,P〉0.05）.The JOA score in each group promoted significantly at one year follow-up （P〈0.05）,but recovery rate in LSPSL was higher than that of conventional group （62±3% vs 43±7%,P〈0.01 ）.In the contrast,the extent of sacrospinalis atrophy of LSPSL group was significantly lower than that of conventional group by the measurement through axial T2 image of MRI （6.4% vs 31% and 6.9% vs 30% at L4/5 and L5/S1 levels respectively,P〈0.001）.2 cases developed peri-incision pain shortly after operation and cured spontaneously in LSPSL group,5 cases developed spinal instability with severe low back pain which had to be managed by pain-killer in conventional group. Conclusion：LSPSL is a simple and effective approach for the patients with LCS,it can achieve thorough decompression for stenosed spinal canal as the conventional method ,meanwhile reduce the injury to the paravertebral muscles,and minimize the postoperative low back pain.