椎板截骨原位回植术治疗腰椎管狭窄症远期疗效分析

Long-term outcomes of total laminectomy and replantation for the treatment of lumbar spinal stenosis

目的观察腰椎全椎板截骨回植术治疗腰椎管狭窄症的远期疗效。方法选择我院1994年2月～2001年12月行椎板截骨原位回植术治疗的腰椎管狭窄症患者152例，随访时间56个月～122个月，平均83个月。通过对患者术前、术后JOA评分，ODI指数，腰腿痛VAS评分，影像学进行随访评估。结果手术时间40～230min，平均97min。术中失血量75～254ml，平均96ml。JOA评分：术前14．2±3．9分，末次随访时24．3±2．8分；ODI指数：术前64．6±10．3％，末次随访时18．5±5．4％；VAS：术前7．4±0．7分，末次随访时1．8±0．5分，JOA好转优良率（80．2％）。手术前后比较上述指标差异均有显著性（P均〈0．01）。平片示椎板骨性融合良好，过屈位无后方椎间隙加宽，无脊柱不稳现象；CT检查示12例单侧椎板未愈合，椎管减压满意，未见愈合过程中有骨痂向椎管内生长。患者自觉手术满意率为94．4％。3例患者因症状复发行2次手术，术中观察到椎板下粘连轻微，容易将椎板和硬脊膜分离，术后2例症状消失，1例腰痛症状加重，严重影响生活。结论腰椎椎板截骨原位回植术可明显减少术后腰椎的失稳和手术部位粘连，中远期临床疗效满意，是治疗腰椎管狭窄症的一种良好术式。

Objective To observe the long-term outcomes of total laminectomy and replantation for the treatment of lumbar spinal stenosis. Methods 152 patients with lumbar spinal stenosis was treated with total laminectomy and replantation from February, 1994 to December, 2001. The follow-up was ranged from 56 to 122 months （mean 83 months） and clinic results were evaluated according to JOA, ODI, VAS scoring system. Results The operation time was 40-230min （mean 97 min）. The blood loss was 75-254ml （mean 96ml）. The clinical results was significantly improved according to JOA scores, ODI and VAS scores （P〈0.01）. All lamina were healed according to X-rays; while 12 cases acquired one-side heal according to CT scans, The decompression of spinal canal was satisfied. The satisfy ratio was 94.4%. 3 cases underwent secondary operation because of recurrence. Fewer adherences under lamina was found during operation. Conclusions The long-term follow-ups show that total laminecotomy and replantation is a useful method to improve clinical outcome, prevent epidural scar formation and lumbar instability after surgery.