半椎板减压联合椎间植骨融合和单侧椎弓根内固定治疗腰椎管狭窄症伴退变性Ⅰ度滑脱34例疗效观察

Effect of unilateral laminectomy combined with spinal fusion and unilateral pedicle screw instrumentation in the treatment of 34 cases of lumbar spinal stenosis with grade 1 degengrative spondylisthesis

目的 观察腰椎管狭窄症伴退变性Ⅰ度滑脱患者经半椎板减压＋椎间植骨融合（单枚Cage）＋单侧椎弓根内固定术治疗的临床效果。方法 回顾分析2008年3月至2012年3月收治的34例诊断为腰椎管狭窄症伴退变性Ⅰ度滑脱的患者,平均年龄（63.4±7）岁,平均病程（48±8）个月。病变平面：L4～520例、L5～S114例。均应用半椎板减压＋椎间植骨＋单侧椎弓根内固定手术方法。采用北美脊柱外科协会的腰椎功能障碍指数（ODI）评价术后3、12个月腰椎功能改善率;采用疼痛视觉模拟评分法（VAS）对术前、术后3、6、12个月随访时的腰痛及腿痛症状进行评分,并对结果进行统计学分析。结果 本组28例患者获得随访,随访时间12～42个月,平均（26±5）个月。术后3、12个月功能改善优良率分别为89.3%、85.8%。术后功能3个月及12个月比较差异无统计学意义（P〉0.05）。术后3个月腰腿痛VAS评分较术前明显减少（P〈0.01）,术后3、6、12个月比较差异均无统计学意义（P〉0.05）。5例患者发生并发症,其中硬脊膜撕裂3例、神经根损伤1例、切口感染1例。随访12个月全部椎间植骨融合没有滑脱及内固定断裂发生。结论 腰椎管狭窄症伴退变性Ⅰ度滑脱患者,采用半椎板减压＋椎间融合＋单侧椎弓根内固定治疗可获得满意的临床效果。

Objective To investigate the clinical results of unilateral laminectomy combined with spinal fu-sion and unilateral pedicle screw instrumentation in the treatment of 34 cases of lumbar spinal stenosis with grade 1 de-gengrative spondylisthesis. Methods From March 2008 to March 2012, 34 patients with degenerative lumbar spinal stenosis with grade 1 degengrative spondylisthesis were enrolled in a restrospective study to investigate the outcome of surgical treatment：the average age was （63.4＆#177;7） year, and the average history was （48＆#177;8） months. All patients were treated by unilateral laminectomy combined with spinal fusion and unilateral pedicle screw instrumentation. Clinical outcomes were evaluated by oswestry disability index （ODI） at 3, 12 months after the operation, and low back and leg pain were evaluated by visual analogue scale （VAS） scores at pre-operation and post-operation at 3, 6, 12 months. Results 28 patients were followed up for 12 to 42 months with a mean period of （26 ＆#177; 5） months. According to the standardization of oswestry disability index （ODI）, the excellent good rate was 89.3%and 85.8%at 3, 12 months re-spectively after operation （P〉0.05）. The VAS score of low back pain and leg pain at 3 month postoperative was lower than at preoperative （P〈0.01）, and there was on significant difference among 3, 6, 12 months （P〉0.05）. Five patients showed complications, including dural tearing in 3 patients, nerve root impingement in 1 patient, and wound infection in 1 patient. All patients gained bone graft fusion in 12 months and on spondylolisthesis and internal fixation breakage during the follow-up. Conclusion Unilateral laminectomy combined with spinal fusion and unilateral pedicle screw instrumentation shows a satisfactory result in lumbar spinal stenosis with grade 1 degengrative spondylisthesis.