开窗减压术和椎板切除减压术治疗腰椎管狭窄症临床疗效比较

The Clinical Effect Comparison between the Selective Interlaminar Fenestration Decompression and Decompressive Laminectomy Retaining Complex Structure of Spinous Ligament for Lumbar Spinal Stenosis

目的比较选择性开窗减压术和保留棘突韧带复合结构的椎板切除减压术在治疗腰椎管狭窄的临床效果。方法回顾性分析43例腰椎管狭窄患者的临床资料,其中行选择性开窗减压术23例(A组),行保留棘突韧带复合结构的椎板切除减压术20例(B组),比较和评价两种手术方法在改善患者疼痛、跛行等临床症状方面的效果。结果手术情况:A组平均手术时间和平均住院时间较B组长,平均出血量少于B组,差异均有统计学意义(P<0.05)。所有患者均获随访,平均时间(23.6±2.4)个月。症状改善情况:A组下肢疼痛和麻木症状完全消失19例(82.6%),有不同程度的缓解3例(13.1%),基本上无改善1例(4.3%);B组完全消失17例(85.0%),缓解3例(15.0%)。A组跛行症状完全消失18例(78.3%),跛行症状基本消失仅偶尔出现者4例(17.4%),完全无缓解者1例(4.3%);B组跛行症状完全消失14例(70.0%),偶尔出现者6例(30.0%)。两组比较差异无统计学意义(P>0.05)。术后疗效评价:A组优14例(60.9%),良7例(30.4%),可2例(8.7%),优良率为91.3%(21/23);B组优13例(65.0%),良5例(25.0%),可1例(5.0%),差1例(5.0%),优良率为90.0%(18/20)。两组临床疗效比较,差异无统计学意义(χ2=6.737,P=0.081)。结论选择性开窗减压术和保留棘突韧带复合结构的椎板切除减压术均为治疗腰椎管狭窄安全有效的手术方法,具体选择何种术式需要综合患者自身情况及病变程度、范围进行选择。

Objective To compare the clinical effect between the selective interlaminar fenestration de- compression surgery and decompressive laminectomy retaining complex structure of spinous ligament in the treat- ment of lumbar spinal stenosis. Methods The clinical data of 43 cases with lumbar spinal stenosis were ana- lyzed retrospectively. Among them, 23 cases （regarded as group A） were treated by selective interlaminar de- compression surgery and 20 cases （regard as group B ） were performed decompressive laminectomy retaining complex structure of spinous ligament. The effect of clinical symptoms were compared between two groups. Results The average operative duration and hospital stay was longer and the blood loss was less in group A than those in group B, there was statistic difference between two groups （ P 〈 O. 05 ）. All cases were followed up for 10 months to 3 years with an average of 23.6 ± 2.4 months. The symptoms of leg pain and numbness was complete disappeared, remission at extent and no improvement in 19 patients （82.6%）, 3 cases （ 13.1% ） and 1 case （4.3%） in group A, and complete disappeared in 17 （85.0%） and release in 3 （ 15.0% ） in group B. The symptom of claudication was completely disappeared in 18 （78.3%）, occasional limp in 4 （ 17.4% ） and complete non-remission in 1 case （4.3%）in group A, and completely disappeared in 14 （70.0%） and occasional limp in 6 （30.0%） in group B. There was no statistic difference between two groups （P 〉 0.05 ）. The outcome revealed excellence in 14 cases （60.9%）, good in 7 cases （30.4%）, fair in 2 cases （8.7%）, and the fineness rate was 91.3% （ 21/23 ） in group A; and excellence in 13 cases （ 55.0% ）, good in 5 cases （25.0%）, fair in 1 cases （5.0%）, poor in 1 case （5.0%）, and the fineness rate was 90.0% （18/20） in group B. There was no statistic difference in result between group A and B （x2 = 6. 737, P = 0. 081 ）. Conclusions Both Selective interlaminar fenestration decompression surgery and decompressive laminectomy retaining complex structure of spinous ligament are effective surgical interventions for lumbar spinal stenosis. The surgical proce- dures would be selected according to the situation of patients and the extent of lumbar spinal stenosis.