后路减压钉棒系统内固定干预腰椎管狭窄的早中期临床分析

Clinical analysis of fixation of posterior decompression screw-rod in internal system for interveninglumbar spinal stenosis

目的 探讨腰椎管狭窄后路减压钉棒系统内固定干预的早中期临床效果.方法 选取骨科2010年1月~2012年1月腰椎管狭窄手术治疗患者38例,按随机数字表分组,对照组15例予单纯后路椎管减压干预,钉棒系统内固定组23例予后路减压钉棒系统内固定治疗,观察两组患者治疗效果、不良反应及早中期疗效.结果 钉棒组平均手术时间、平均术中出血量分别为（2.3±0.9）h和（235.8±35.2）ml,均低于对照组,差异有统计学意义（P＜0.05或＜0.01）.钉棒组总有效率为91.30%（21/23）,对照组总有效率为60.00%（9/15）,钉棒组比传统组有明显优势,差异有统计学意义（P＝0.0391）.术前及术后3个月、6个月两组患者JOA评分比较差异无统计学意义（P＞0.05）;钉棒组患者术后12个月、24个月评分分别为（25.6±3.1）分和（25.0±3.3）分,均明显优于对照组（P＜0.05）.结论 在腰椎管狭窄治疗中使用后路减压钉棒系统内固定,其作用不仅提高了骨融合率,同时还改善了患者的长期疗效.

Objective To explore the clinical effect of fixing posterior decompression screw-rod in internal system for intervening lumbar spinal stenosis. Methods 38 cases undergoing lumbar spinal stenosis surgery from Jan,2010 to Jan,2012 were divided into the control group（15 cases） and the screw-rod fixation group（23 cases） according to random number table.The control group were given simple posterior vertebral canal decompression, and the other group were given fixation of screw-rod with posterior vertebral canal decompression in internal sys- tem for intervention.Then, the therapeutic effects,adverse reactions and treatment effects in early-to-middle term of both groups were observed.Results The mean operating time and mean intraoperative bleeding amount of the screw-rod fixation group were （ 2.3 ± 0.9） h and （ 235.8 ± 35.2 ） ml, significantly lower than those of the control group, so the difference was statistically significant （ P 〈0.05 or 0.01）.The total effective rate of the screw-rod fixation group was 91.30%0 （21/23） ,and that of the control group was 60G （9/15）, which showed that the former group had more advantages than the latter group and the difference was statistically significant （ P = 0. 0391）. No significant differences were found in the comparison of JOA scores before treatment,3 months and 6 months after treatment between two groups（ P 〉0.05）.The JOA score of the screw-rod fixation group in the 12th month and 24th month after treament were （25.6±3.1） and （25 ± 3.3）, respectively, significantly better than those of the control group （ P 〈0.05）.Conclusion To fix screw-rod with posterior decompression in internal system in the treatment of lumbar spinal stenosis can not only improve bone fusion rate,but also improve the long-term therapeutic effect of patients.