有限椎板切除椎板减压术治疗腰椎管狭窄症的临床研究

Clinical study on Limited Decompressive Laminectomy in Treating Lumbar Spinal Stenosis

目的研究有限椎板切除椎板减压术与全椎板切除椎间融合内固定术治疗腰椎管狭窄症的疗效。方法将内蒙古自治区2011年1月至2012年12月呼伦贝尔市人民医院骨科收治的75例腰椎管狭窄症患者纳入研究,其中35例接受有限椎板切除椎板减压术治疗的患者作为观察组,40例接受全椎板切除椎间融合内固定术治疗的患者作为对照组。观察两组患者手术相关指标以及手术前后的腰痛情况。结果观察组患者的手术时间[(93.8±17.4)min vs(148.2±26.9)min,t=5.982、P<0.05]、术中出血量[(42.8±9.3)mL vs(104.9±19.4)mL,t=8.782,P<0.05]、术后下床活动时间[(4.2±0.9)d vs(7.3±1.8)d,t=6.985,P<0.01]、住院总时间[(7.5±1.3)d vs(12.4±3.1)d,t=7.227,P<0.05)]及住院总费用[(4.6±0.8)万元vs(12.4±2.8)万元,t=10.856,P<0.05)]均低于对照组;术后1个月时两组患者疼痛数字评价量表评分评分[(8.3±1.1)分vs(8.1±1.5)分,t=0.893,P>0.05]、日本骨科学会腰痛量表评分评分[(4.2±0.8)分vs(4.3±1.0)分,t=0.683,P>0.05]及改善率[(61.3±11.4)%vs(60.9±13.2)%,t=1.423,P>0.05]比较差异无统计学意义;术后6个月、1年时,观察组的VAS评分低于对照组、改善率及JOA评分高于对照组,差异有统计学意义(P<0.05)。结论与全椎板切除椎间融合内固定术相比,有限椎板切除椎板减压术能够减小手术创伤,改善远期疗效。

Objective To study the effect of limited decompressive laminectomy and complete laminectomy in treating lumbar spinal stenosis.Methods A total of 75 cases of patients with lumbar spinal stenosis admitted in Department of Orthopedics,Hulun Buir People＇s Hospital from Jan.2011 to Dec.2012 were enrolled in the research,including 35 patients treated with limited decompressive laminectomy as the observation group and 40 patients treated with complete laminectomy as the control group.Then operation related indexesand condition of low back pain before and after operation of the two groups were observed.Results Indexes of the observation group：operation time（93.8 ± 17.4 vs 148.2 ± 26.9 min,t =5.982,P ＜ 0.05）,intraoperative bleeding amount（42.8 ± 9.3 vs 104.9 ± 19.4 ml,t =8.782,P ＜ 0.05）,postoperative ambulation time（4.2 ± 0.9 vs 7.3 ± 1.8d,t =6.985,P ＜ 0.05）,hospitalization time[（7.5 ± 1.3） vs （12.4 ± 3.1） d,t=7.227,P＜0.05] and total costs（46 ±8 vs 124 ±28 thousand yuan,t=10.856,P ＜0.05）,all of the above indexes were lower than the control group ; one month after operation,there was no statistically significant difference between the two groups in VAS score（8.3 ± 1.1 vs 8.1 ± 1.5,t=0.893,P ＞ 0.05）,JOA score（4.2 ± 0.8 vs 4.3 ± 1.0,t =0.683,P ＞ 0.05） and improvement rate[（61.3 ± 11.4）％ vs （60.9 ± 13.2）％,t =1.423,P ＞ 0.05] ; six months and one year after operation,VAS score of the observation group was lower than the control group,while JOA score and improvement rate of the observation group were higher than the control group,the differences were statistically significant（P ＜ 0.05）.Conclusion Compared with complete laminectomy,limited decompressive laminectomy can reduce operative trauma and improve the long-term efficacy.