全椎板切除脊柱内固定对老年退行性腰椎管狭窄症患者功能恢复的效果评价

The effect of laminectomy spine fixation on restore function in treatment of patients with degenerative lumbar spinal stenosis

目的：探讨全椎板切除脊柱内固定对老年退行性腰椎管狭窄症患者功能恢复的效果。方法收集退行性腰椎管狭窄症患者60例，按照简单随机法分成观察组及对照组各30例。观察组采用全椎板切除减压联合脊柱内固定术，对照组采用部分椎板切除减压联合脊柱内固定术，观察其治疗效果。结果与术前比较，两组术后神经功能恢复情况进行分析，在 A 级、B 级、D 级及 E 级方面差异有统计学意义（χ2＝6．392、6．203、7．213、7．382，均 P ＜0．05）。与对照组比较，观察组在 A 级、B 级、D 级及 E 级方面差异有统计学意义（χ2＝6．012、6．102、7．124、7．203，均 P ＜0．05）。与术前比较，患者术后3个月的椎管直径为（17．2±3．1）mm，末次随访时为（16．8±2．7）mm，差异有统计学意义（t ＝6．391、7．692，均 P ＜0．05）。患者术后3个月、末次随访椎管直径差异无统计学意义（t ＝0．592，P ＞0．05）。结论手术是治疗老年退行性腰椎管狭窄最为有效的治疗方式。通过后路椎间盘镜采用椎管减压措施，再次进行椎弓根内固定、椎间植骨融合方式，预后良好，值得临床推广使用。

Objective To investigate the effect of laminectomy spine fixation on restore function in treatment of patients with degenerative lumbar spinal stenosis.Methods 60 patients with degenerative lumbar spinal stenosis were selected and divided into the observation group and control group with 30 patitents respectively.Patietns in the observation group were taken with laminectomy decompression of spinal fixation,while patients in the control were treated with part laminectomy decompression of spinal fixation.The treatment effect was observed.Results Compared with the preoperative data,postoperative neurologic recovery of the two groups were analyzed in A grade,B grade,D and E grade level terms after comparison analysis,the difference was statistically significant （χ2 =6.392,6.203, 7.213,7.382,all P 〈0.05）.Compared with the patients of the control group,comparison analysis of A grade,B grade,D and E grade level terms in the patients of the observation group had a statistically significant difference （χ2 =6.012,6.102,7.124,7.203,all P 〈0.05）.Compared with the preoperative data,the resuts of postoperative 3 months showed canal diameter of （17.2 ±3.1）mm,at last follow -up was （16.8 ±2.7）mm.After a comparative analysis,the differences were statistically significant （t =6.391,7.692,all P 〈0.05）.Patients after three months,the diameter of the spinal canal comparative analysis of last follow -up,the difference was not statistically significant （t =0.592,P 〉0.05 ）.Conclusion Surgery is the treatment of degenerative lumbar spinal stenosis disease the most effective treatment.Measures taken by posterior spinal decompression discectomy,again with pedicle fixation and interbody fusion approach,can make a good prognosis,and isworthy of clinical use.