三种手术方法治疗腰椎管狭窄症的疗效分析

Clinical Efficiency of Lumbar Spinal Canal Stenosis Treated with Three Surgical Methods

目的评价三种手术方法治疗腰椎管狭窄症(LSS)的疗效。方法采集泰安市中心医院骨科2005年7月-2011年12月所治疗的腰椎管狭窄症中有随诊记录的86例,男40人,女46人,按照不同的手术方式分为3组,术后定期复查,并进行JOA评分。比较3组病例术后3个月及36个月的腰椎稳定性及JOA评分系统改善率,进行统计学分析。结果 3组病例中随访3个月时3组病例稳定性无显著性差别,随访36个月3组病例稳定性无显著性差别J,OA评分系统优良率的比较3,个月时三组间的优良率无显著性差异,36个月时三组间的优良率无显著性差异。B,C组病例的优良率要高于A组病例。结论三种手术方式均能取得减压的效果,但保留棘上韧带的全椎板截骨回植椎管成形术治疗腰椎管狭窄症显露充分,减压更彻底可靠,明显减少术后腰椎的失稳,尽量避免了医源性椎管狭窄的发生。

Objective To evaluate the clinical efficiency of three surgical methods to treat lumbar spinal canal stenosis.Methods 86 patients with lumbar spinal canal stenosis were selected from July 2005 to December 2011 in Tai＇an Central Hospital.Based on the surgical methods,they were divided into three groups： Group A（26 cases,the surgery resects of part laminectomy）,Group B（29 cases,the surgery resects of total laminectomy and replantation）,Group C（31 cases,total laminectomy and replantation with preservation of supraspinal ligament）.After surgery,they were examined regularly and assessed for JOA scores.The therapeutic effect was assessed based on the JOA scoring system and lumbar stability among the three groups.Results There was no significant difference in lumbar stability among the three groups 3 months and 36 months after surgery.When comparing the rate of improvement derived from JOA scoring system,the author found no significant difference（P 0.05） among the three groups after 3 months.Group B and Group C had a higher rate of improvement than Group A.Conclusions All three surgical methods could reduce pressure in the lumbar spinal canal.To treat the lumbar spinal canal stenosis,the method of total laminectomy and replantation with preservation of supraspinal ligament is better,for it is beneficial to spinal stability,which can avoid iatrogenic stenosis of spinal canal.