显微椎管减压和椎板切除治疗退变性腰椎管狭窄症疗效比较

Comparative study of degenerative lumbar vertebral canal stenosis treated by microscopic spinal decompression and laminectomy decompression

目的分析眼镜式放大镜下显微椎管减压以及椎板切除减压治疗退变性腰椎管狭窄症的临床疗效。方法 2006年1月-2011年5月在眼镜式放大镜下行显微减压治疗退变性腰椎管狭窄症患者42例,椎板切除减压治疗退变性腰椎管狭窄症患者67例,术前、术后1周内及术后1、3、6、18个月时应用Oswestry功能障碍指数(ODI)评分法对患者进行评定,并进行综合满意度评估。结果均顺利完成手术,显微组单节段手术时间较长,出血少,4例患者发生硬膜破裂,给予相应处理后痊愈,椎板组手术时间较短,出血多,5例患者发生硬膜破裂,给予相应处理后痊愈。两组患者术后无神经根损伤、感染及腰椎失稳等并发症发生,重复测量设计方差分析显示组内手术前后评分、组间在术后1周以及1个月内评分差异有统计学意义(P<0.05)。术后18个月评分差异无统计学意义(P>0.05),手术综合满意程度评估,显微组优32例,良6例,可4例,优良率90%,椎板组优43例,良13例,可11例,优良率84%。结论眼镜式放大镜下显微减压和椎板切除治疗退变性腰椎管狭窄症均可以获得良好的疗效。

【Objective】 To compare the clinical effects of micro-decompression and traditional operation for degenerative lumbar vertebral canal stenosis. 【Methods】 42 patients of degenerative lumbar spinal canal stenosis（17 patients with single segment and 25 patients with double segments） treated by microscopic spinal decompression and 67 patients（26 patients with single segment and 41 patients with double segments） treated by traditional operation from January 2006 to May 2011 were reviewed, all patients were evaluated by ODI（oswestry disability index） before operation and 18 months after operation,and by the rate of general satisfaction to the operation as well. 【Results】 All the cases were operated successfully. It was found that the blood loss in operation of micro-decompression group is less than that of traditional operation group（P〈 0.05）,In terms of ODI before operation, two groups were remarkably low（P〈 0.05）, and there were significant differences in ratings between the two groups within three months, no significant difference after 6 months.【Conclusion】 Micro-decompression and traditional spinal canal decompression for degenerative lumbar vertebral canal stenosis can obtain good curative effect.