显微椎管减压术与传统椎管减压术治疗腰椎管狭窄症的比较性研究

Comparison of Micro-decompression and Traditional Spinal Canal Decompression for Lumbar Spinal Stenosis

目的比较显微镜下减压与传统开放手术减压治疗腰椎狭窄症的临床疗效。方法2008年12月～2010年12月手术治疗腰椎狭窄症患者90例,其中48例行显微镜下椎管减压术治疗(A组),42例采用传统开窗减压术(B组)。比较两组手术时间、术中出血量、平均下地时间、平均住院时间及术后症状缓解等方面的指标。采用日本骨科协会JOA评分、Oswestry功能障碍指数问卷表(ODI)和视觉模拟评分(VAS)对两组术前和术后1周、3个月、6个月、12个月、18个月治疗效果进行评定。结果两组均顺利完成手术,伤口一期愈合,无神经损伤、感染等并发症,B组2例硬膜破裂,术中修补。A组手术时间较B组长,但术中出血量、术后下地活动时间及住院时间均显著少于B组(P<0.01)。两组术后3月至18月腰腿痛VAS评分及ODI、JOA评分均较术前显著改善(P<0.01),但组间比较无统计学差异(P>0.05)。结论显微减压术治疗腰椎管狭窄症具有创伤小、出血少、恢复快的优点,是一种有效的微创治疗腰椎管狭窄症的方法,较传统椎管减压术有明显优势。

Objective To compare the clinical effects of micro-decompression and traditional spinal canal decompression for lumbar spinal stenosis.Methods A total of 90 cases suffered lumbar spinal stenosis admitted from December 2008 to December 2010 were analyzed retrospectively.All cases were treated by surgical intervention,including 48 of micro-decompression（regard as group A） and 42 of traditional spinal canal decompression（regard as group B）.The operative time,intraoperative blood loss,recover time of bedside exercise,hospitalization time and postoperative symptomatic relief were compared between two groups.The outcomes were assessed in two groups before the operation,1 week,3-,6-,and 18 months after the operation according Japanese Orthopaedic Association（JOA）,Oswestry Disability Index（ODI） and Visual Analog Scores（VAS）.Results All cases were accomplished surgery and achieved primary wound healing without nerve injury or infection.Rupture of dura mater was found and repaired during operation in 2 cases of group B.Compared to group B,the operative duration was longer,the intra-oeprative blood loss,recovery time of activity and hospital stay time was less in group A（P0.01）.The VAS of lumbago,ODI and JOA was obviously improved at the time point of 3,6,12 and 18 months after operation than those at the time point of pre-operation respectively in both two groups（P0.01）,but there was no statistic difference in VAS,ODI and JOA between two groups at the time points of 3,6,12 and 18 months after operation（P0.05）.Conclusion The surgery of micro-decompression is an effective treatment for lumbar spinal stenosis with advantages of small trauma,less blood loss and quick recovery,and it is superior to traditional spinal canal decompression.