单纯开窗减压与减压复位融合内固定术治疗Ⅰ、Ⅱ度真性腰椎滑脱症的临床疗效

Comparative study on clinical results of simple decompression versus decompression fusion with internal fixation for true lumbar

目的探讨单纯开窗减压术与减压复位融合内固定术治疗Ⅰ、Ⅱ度真性腰椎滑脱症的临床疗效。方法选择2008年6月-2010年6月新疆医科大学第六附属医院脊柱外科收治的75例Ⅰ、Ⅱ度真性腰椎滑脱症住院患者,按手术术式分为单纯开窗减压组(A组,35例)和减压复位融合内固定组(B组,40例),比较2种术式手术时间、出血量及术后3个月、1a随访时日本骨科协会评估治疗(JOA)评分、腰腿痛视觉模拟评分法(VAS)评分、滑脱率、滑脱角、椎间隙高度变化。结果 A组手术时间、出血量明显少于B组(P<0.05),A组有4例患者术后根性症状缓解不明显,其中2例随访观察3个月后症状缓解,2例行复位融合内固定术后症状缓解,1a后随访有4例患者腰椎滑脱程度加重并出现根性症状。B组术中1例出现脑脊液漏术中行缝合修补,神经根损伤1例。3个月时两组JOA评分差异无统计学意义(P>0.05),1a时两组评分差异有统计学意义(P<0.05)。两组术后3个月、1a时腰腿痛VAS评分较术前明显降低,其中术后3个月时A组与B组腰腿痛VAS评分差异无统计学意义(P>0.05),A组术后1a随访时腰腿痛VAS评分与B组比较,差异有统计学意义(P<0.05)。术后3个月、1a行腰椎X线复查,A组滑脱率、滑脱角度及椎间隙高度无明显改变。B组术后3个月、1a复位情况良好,术前术后滑脱率、滑脱角、椎间隙高度变化差异均有统计学意义(P<0.05)。结论单纯开窗减压术与减压复位融合内固定术2种术式治疗Ⅰ、Ⅱ度真性腰椎滑脱症早期的临床疗效无明显差异,前者手术创伤小、时间短,所以患者耐受较好,但单纯开窗减压术的远期疗效不如减压复位融合内固定术。

Objective To compare the differences in clinical results between two kinds of surgical treat-ments：simple decompression and decompression fusion and internal fixation for true lumbar spondylolis-thesis of Ⅰ,Ⅱ degree.Methods According to the surgical treatment,75 hospitalized patients were divid-ed into simple decompression （group A,35 patients）and decompression fusion and internal fixation （group B,40 patients）from June 2008 and June 2010.The operation time,blood loss,JOA score,VAS score,slip rate,slip Angle and intervertebral height change of 2 groups were compared after 3 months and 1a postoperative follow-up.Results It took less operation time for group A,which had less blood loss＆amp;nbsp;than group B （P ＆lt;0.05）.Postoperative symptoms of 4 cases in group A were not obviously relieved;2 ca-ses followed for 3 months were relieved and the remaining 2 cases were relieved after bone graft fusion with internal fixation.The degree of lumbar spondylolisthesis of 4 cases followed for 1a was aggravated and nerve root injury occurred.In the operation cerebrospinal fluid leakage occurred in 1 case of group B and treated for suture repairing and nerve root injury occurred in 1 case.Postoperative JOA scores of 2 groups had no statistically significant difference after 3 months （P ＆gt;0.05）,but had difference after 1a （P＆lt;0.05）.VAS score for back and leg pain in each group decreased obviously both after 3 months and 1a. VAS score for lumbago was not statistically different in 2 groups 3 months after operation （P ＆gt; 0.05）. Compared with group B,VAS score for lumbago in group A had statistical significance followed for 1a af-ter the operation （P ＆lt;0.05）.3 months and 1a after the lumbar spine X-ray check,the slippage rate,slip angle and intervertebral disc height of group A were not obviously changed.The slippage rate,slip angle and intervertebral disc height of group B were obviously reduced,which was significantly different from the preoperative condition （P ＆lt;0.05）.Conclusion The clinical results of simple decompression and de-compression fusion with internal fixation had no significant difference in treating true lumbar spondylolis-thesis of Ⅰ,Ⅱ degree.The former was better-tolerated for less surgical trauma,less bleeding and less op-eration time.But the long-term curative effect of simple decompression was not as good as that of decom-pression fusion with internal fixation.