后路减压自体碎骨椎间打压植骨固定治疗退变性腰椎管狭窄症的疗效观察

Treatment of degenerative lumbar spinal stenosis with autogenous bone graft and intervertebral impaction combined with posterior decompression

目的 评价后路减压自体碎骨椎间打压植骨固定治疗退变性腰椎管狭窄症的临床疗效并探讨手术适应证.方法 采用后路减压自体碎骨椎间打压植骨固定手术方式治疗90例退变性腰椎管狭窄症患者,患者均经保守治疗6个月以上且治疗无效.应用Japanese Orthopaedic Association Scores （JOA）评分标准和影像学指标变化对术后疗效进行评价.结果 74例患者获得随访,平均15个月（12～24个月）.术前椎间隙高度（4.5 ±2.8） mm,术后（12.3 ±2.5）mm（P＜0.05）.术前腰椎前凸角（-31±11）.,术后（-47±7）.（P＜0.05）.术前JOA评分为（14.5±3.92）分,术后（24 ±2.65）分（P＜0.05）,JOA评分改善率为65％～100％,平均76％.结论 只要适应证得当,后路减压自体碎骨椎间打压植骨固定治疗退变性腰椎管狭窄症,能够恢复椎间隙高度和改善腰椎生理前凸,不需另外取骨,有效缓解临床症状,疗效确切.

Objective To evaluate the treatment effect and operative indications of degenerative lumbar spinal stenosis with posterior decompression,autogenous bone graft and intervertebral impaction.Methods A total of 90 patients with degenerative lumbar spinal stenosis were treated with posterior decompression,autogenous bone graft and intervertebral impaction.All enrolled patients used to receive conservative treatment for more than 6 months and ineffective treatment.The effect was evaluated using Japanese Orthopaedic Association Scores （JOA） and changes of radiographic parameters.Results Seventy-four patients were followed up for 12 ～ 24 months with a mean value of 15 months.The preoperative interbody height was （4.5 ± 2.8） mm and turned as （12.3 ± 2.5） mm postoperatively （P ＜ 0.05）.The preoperative lumbar lordosis angle was （-310 ± 110）degree and then turned as （-47 ± 70）degree postoperatively （P ＜ 0.05）.The preoperative JOA score was （14.5 ± 3.92） points and then turned into （24 ± 2.65） points postoperatively （P ＜ 0.05）.The improve rate of JOA score was 65 ～ 100％ with an average improve rate of 76％.Conclusion As long as the indication is proper,this technique is effective for restoring interbody height and improving lumbar lordosis,which could effectively relieve the symptoms without additional bone harvest.