有限减压、固定、融合术在退行性腰椎管狭窄症治疗中的应用

The application of limited decompression, fixation and fusion on the patients with degenerative lumbar spinal stenosis

目的探讨有限减压、固定、融合术治疗退行性腰椎管狭窄症的效果。方法92例退行性腰椎管狭窄症患者按照数字表法随机分为两组，观察组46例，采用有限减压、固定、融合治疗，对照组46例，采用全椎板切除减压内固定植骨融合治疗。观察两组患者手术时间、术中出血量及住院时间。随访6个月，比较两组JOA评分。结果观察组在手术时间、术中出血量及住院时间方面均少于对照组（t=6．092、7．114、3．714，均P〈0．05）。平均随访6个月，两组JOA评分术前差异均无统计学意义（均P〉0．05），观察组与对照组术后1个月、术后3个月JOA评分差异无统计学意义（t=0．810、0．901，均P〉0．05），观察组术后6个月JOA评分高于对照组（t=4．014，P〈0．05）。术后6个月，观察组优良率为78．3％，对照组优良率为67．4％，观察组明显高于对照组（x2=7．210，P〈0．05）。结论有限减压、固定、融合术治疗退行性腰椎管狭窄症对患者创伤小，疗效显著。

Objective To study the effectiveness of limited decompression,fixation and fusion on the patients with degenerative lumbar spinal stenosis. Methods 92 patients with degenerative lumbar spinal stenosis were ran- domly divided into two groups, the observation group （n = 46 cases ） who were operated through limited decompres- sion,fixation and fusion,and the control group（ n =46 cases） who were operated through the lamina resection decom- pression and internal fixation and interbody fusion. Two groups were observed about surgery time, blood loss and length of hospital stay. Follow-up for 6 months, the two groups of JOA score was compared. Results In the observation group, operative time, blood loss and length of hospital stay were shorter than that of the control group （ t = 6. 092, 7.114,3.714, all P 〈 0.05）. The average follow-up of six months, the two groups of preoperative JOA score and VAS scores were not significantly different （ all P 〉 0.05 ）. After 1 month, 3 months after operation, the JOA score was no significant difference between the observation group and the control group （ t = 0.810,0. 901, P 〉 0.05 ）. JOA score in the observation group after 6 monthe of operation was higher（ t = 4. 014, P 〈 0.05）. After 6 months, excellent rates were 78.3% in the observation group and 67.4% in the control group. The observation group was significantly higher than the control group （ X2 = 7. 210, P 〈0. 05）. Conclusion Limited decompression, fixation and fusion had a low trauma and significant effect for patients with degenerative lumbar spinal stenosis.