棘突劈开椎管减压术联合椎旁入路椎弓根技术治疗退变性椎管狭窄症疗效分析

The curative effect analysis of spinous process splitting decompression combined with paravertebral approach pedicle screws technique for the treatment of degenerative lumbar spinal stenosis

目的对比研究棘突劈开椎管减压术联合椎旁入路椎弓根技术与单纯棘突劈开椎管减压术治疗单节段腰椎管狭窄症的临床疗效。方法将77例单节段腰椎管狭窄患者随机分为联合入路组(A组39例)和单纯棘突劈开组(B组38例),评估两组围手术期参数,JOA、VAS改善率及术后并发症发生率。结果 A组手术时间较B组长(P<0.05),术中出血量较B组多(P<0.05),但两者术后出血量之间差异无统计学意义(P>0.05),两组术后第1天肌酸激酶之间差异无统计学意义(P>0.05)。在JOA及VAS改善率方面,A组较B组改善明显(P<0.05);A、B两组椎间不稳发生率分别为2.6%及21.1%,差异有统计学意义(P<0.05);术后A、B两组翻修率分别为7.7%及26.3%,差异有统计学意义(P<0.05)。结论在治疗单节段腰椎管狭窄症上,棘突劈开椎管减压术联合椎旁入路椎弓根技术与单纯棘突劈开椎管减压术相比,具有更牢固的椎间稳定性,可以减小术后翻修的几率,缓解术后疼痛,改善患者生活质量。

Objective To investigate the clinical efficacy of lumbar spinal stenosis treated with spinous process splitting decompression combined with paravertebral approach pedicle screws technique. Methods 77 patients with single level lumbar spinal stenosis were randomly divided into combined approches group（group A, n=39） and conventional group （group B, n=38） according to treatment method. Perioperative parameters, VAS and JOA improvement rate and postoperative complications rate were assessed. Results The operation time of group A was longer than group B （P〈0.05）, and the amount of bleeding during operation of group A was larger than group B （P〈0.05）, but there was no significant difference between the two groups with postoperative blood loss （P〉0.05）. Creatine kinase on the first day after operation had no significant difference between the two groups （P〉0.05）. JOA and VAS in group A significantly improved compared with group B （P〈0.05）. The incidence of interver- tebral instability of group A and group B was 2.6% and 21.1%, there was statistically significant difference between the two groups （P〈0.05）. The revision rate of group A and group B was 7.7% and 26.3% respectively, which had no significant differ- ence between the two groups （P〈0.05）. Conclusion Spinous process splitting decompression combined with paravertebral approach pedicle screws technique has great effect with more intervertebral stability, less revision rate, less postoperative pain, better quality of life compared with only spinous process splitting deeomoression in the treatment of lumbar sninal stenosis.