颈、胸、腰椎多节段椎管狭窄症行减压手术的临床疗效

Clinical curative effect analysis of one-staged spinal cord decompression for multilevel spinal stenosis in cervical,thoracic and lumbar

目的分析颈、胸、腰椎多节段椎管狭窄症患者行一期椎管减压术的临床疗效。方法收集2009年10月~2012年5月解放军第八十九医院脊柱外一科收治的颈、胸、腰椎管狭窄症患者临床资料7例,均施行一期椎管扩大减压手术,从手术时间、出血量、日本骨科学会颈髓病评分评级标准（Japanese Orthopaedic Association,JOA-C）、日本骨科学会下腰痛评分评级标准（Japanese Orthopaedic Association,JOA-B）、Oswestry功能障碍指数（Oswestry disability index,ODI）、住院时间、围手术期并发症、患者满意度等方面来分析一期椎管减压术的临床疗效。结果 7例患者均得到随访,手术时间180~430 min,平均263 min。术中出血量350~1 500 m L,平均632 m L;JOA-C、JOA-B评分术前分别为（12.6±1.5）分、（14.2±5.3）分,术后（15.6±1.9）分、（20.2±5.5）分,术前术后差异具有统计学意义（P〈0.05）;ODI术前（57.8±7.6）%,术后（28.3±6.8）%,术前术后差异具有统计学意义（P〈0.05）。患者总体满意度为85.71%（6/7）。结论对颈、胸、腰椎多节段椎管狭窄症患者行一期椎管扩大减压手术,有一定临床效果,可改善患者生活质量。

Objective Retrospective analysis of one-staged spinal cord decompression for multilevel spinal stenosis in cervical,thoracic and lumbar.Methods From Octomber 2009 to May 2012,7 patients with multilevel spinal stenosis in cervical,thoracic and lumbar treated surgically were included.Clinical outcomes were evaluated using the operation time,estimated blood loss,Japan Orthopaedic Association score for back pain（ JOA-B）,cervical myelopathy（ JOA-C） and activity of daily life and Oswestry disability index（ ODI）,hospital stay time,hospitalization costs,perioperative complications.Patients＇ satisfaction was evaluated at final follow-up.Results Seven patients were all followed up.Operation time is 263 min in average（ 180-430 min）.Blood loss is 632 m L in average（ 350-1 500 m L）.JOA-C and JOA-B scores at per-operation were12.6 ± 1.5 and 14.2 ± 5.3,respectively.JOA-C and JOA-B scores at post-operation were 15.6 ± 1.9 and 20.2 ± 5.5,respectively.The difference of JOA-C and JOA-B scores was statistically significant between per-operation and post-operation（ P〈0.05）.The ODI at per-operation was（ 57.8 ± 7.6） %,and was（ 28.3 ± 6.8） % at post-operation,and the difference was statistically significant（ P〈0.05）.Six patients（ 85.71%） were satisfied.Conclusion One-staged spinal cord decompression for multilevel spinal stenosis in cervical,thoracic and lumbar provides positve outcomes and improves patients＇ quality of life significantly.