102例退行性腰椎滑脱合并椎管狭窄的手术治疗体会

Surgical strategy and follow up study of degenerative lumbar spondilolistbesis with stenosis

目的探讨腰椎管狭窄症伴腰椎退变性滑脱的手术方法及其疗效。方法 2004年2月～2009年2月共102例退行性腰椎滑脱合并椎管狭窄纳入研究,随机分为治疗组(棘突截骨椎体成形术47例)和对照组(椎板切除减压椎弓根内固定融合术55例),对比研究两组的治疗效果。结果所有患者均获得完整随访,平均随访时间(2.4±0.3)年。治疗组治疗优良率为74.5%,对照组为72.7%,对比差异无统计学意义(P>0.05)。治疗组平均手术时间为(114±16)min,平均失血量为(512±65)ml,对照组平均手术时间和失血量分别为(155±23)min和(746±84)ml,两组对比差异有统计学意义(P<0.05)。结论棘突截骨椎体成形术腰椎管狭窄症伴腰椎退变性滑脱具有操作简单、椎管中央和侧方减压充分、对腰椎后方张力带结构影响小等优点,且有助于保持腰椎术后稳定,可以作为椎板切除减压椎弓根内固定融合术的替代治疗方法。

Objective To analyse surgical techniques and effect for degenerative lumbar spondilolisbesis with stenosis.Methods 102 cases were taked in this sdudy,and was divided into treatment group（spinous process osteotomies and canaloplasty 47 cases） and control group（lamlnectomy and internal fixation and fusion）.Results The average followed up of All patients was 2.4±0.3 years.The good rats of treatment group was 74.5% and 72.7% of control group,it shows no significant defference（P﹥0.05）.There was significant defference between the two groups in mean operation time and bleeding.The mean operation time of treatment group was（114±16）min,and mean bleeding was（512±65）ml,（155±23）min and（746±84）ml of control group.Conclusion Spinous process osteotomies and canaloplasty for patients suffering from degenerative lumbar spondilolisbesis with stenosis affords easy performing,excellent decompression,while minimizing destruction to the posterior structure.It suggest that this technique could take the place of lamlnectomy and internal fixation and fusion for treatment of degenerative lumbar spondilolisbesis with stenosis.