经椎板间隙扩大减压结合腰椎融合内固定术治疗退变性腰椎管狭窄症

Treatment of Degenerative Lumbar Spinal Stenosis by Decompression in Enlargement of the Spinal Canal with Translaminar Osteotomy and Internal Fixation with Lumbar Fusion

目的观察经椎板间隙扩大减压结合腰椎融合内固定术治疗退变性腰椎管狭窄症的疗效,探讨该术式较全椎板减压术的优势。方法选择2008年1月～2009年3月腰椎管狭窄症患者25例,均应用经椎板间隙扩大减压结合腰椎融合内固定术治疗。结果术后1天JOA评分改善率25%～100%,平均63.5%,3个月随访时JOA评分改善率34%～100%,平均72.3%,术后及随访时JOA评分均较术前有显著提高(P<0.05)。随访时X线平片,所有病例均无腰椎不稳征象,内置物无松动、断裂、变形。结论经椎板间隙扩大减压结合腰椎融合内固定术是一种治疗腰椎管狭窄症的有效方法,能够减少全椎板切除减压带来的术后腰痛等问题;其远期疗效有待进一步观察。

Objective To observe the efficacy on degenerative lumbar spinal stenosis treated by decompression in enlargement of the spinal canal with translaminar osteotomy and internal fixation with lumbar fusion and explore the advantages of this surgery as compared with decompression laminectomy.Methods25 cases of lumbar spinal stenosis were selected from January 2008 to March 2009 and were treated by decompression in enlargement of the spinal canal with translaminar osteotomy and internal fixation with lumbar fusion.ResultsThe improvement rate of JOA scoring 1 day after operation was in the range from 25% to 100%,averagely 63.5%.The improvement rate of JOA scoring in follow-up visit of 3 months ranged from 34% to 100%,averagely 72.3%.JOA score was improved significantly after operation and in follow-up visit as compared with that before operation（P0.05）.In follow-up visit,X-ray flat film indicated that all of the cases had no unstable sign of lumbar vertebrae and no loose,cracks and deformity of implant.ConclusionThe decompression in enlargement of the spinal canal with translaminar osteotomy and internal fixation with lumbar fusion is a kind effective method in the treatment of lumbar spinal stenosis and can reduce post-operative pain induced by decompression laminectomy.But the long-term efficacy of it needs a further observation.