后路腰椎全椎板减压术后腰椎失稳对预后的影响

Effects of lumbar instability after lamina decompression on prognosis

目的探讨腰椎全椎板减压术后患者腰椎失稳对其症状改善的影响。方法获得4年以上随访的全椎板减压患者76例。通过末次随访的影像学资料将患者分为失稳组27例以及无失稳组49例。比较2组术前、术后3个月以及末次随访的视觉模拟(VAS)评分、日本骨科学会下腰痛评分标准(JOA)评分及改善率(改善率≥50%为改善)的差异。结果 2组性别、年龄及平均随访时间差异无统计学意义。2组间术前、术后3个月及末次随访VAS和JOA评分差异无统计学意义;依随访时间延长,各组术后VAS评分均降低,JOA评分增加(P<0.05)。失稳组、无失稳组改善率[(80.0±8.8)%vs(83.6±11.7)%]和改善比例[81.48%(22/27)vs 61.22%(30/49)]差异无统计学意义(P>0.05)。结论腰椎全椎板减压术后部分患者存在影像学上失稳甚至滑脱表现,但其与患者症状改善无关。在严格把握适应证的前提下,后路全椎板减压术操作简单,同时保护了患者脊柱运动功能。

Objective To study the influence of spinal instability after lamina decompression in symptoms and progno-sis. Methods The 76 patients were followed up for a minimum of 4 more years. The patients were divided into instabilitygroup（n=27） and non-instability（n=49） group according to the X-ray result of the final follow-up. The visual analogue scale（VAS） score, JOA score and improvement rate were compared between two groups at preoperation, 3-month after operationand the final follow-up. Results There were no significant differences in gender, age and mean follow-up time between twogroups. There were no significant differences in VAS and JOA scores before surgery, 3-month after surgery and final follow-up between two groups. Postoperative VAS score decreased and JOA score increased with the increase in follow-up time（P〈0.05）. There were no significant differences in improvement rate [（80.0±8.8）% vs（83.6±11.7）%] and improvement ratio[81.48%（22/27） vs 61.22%（30/49）] between two groups（P 〉0.05）. Conclusion Although some patients show instabilityeven with lumbar spondylolisthesis after lamina decompression on radiograph,which is no correlation with improvement ofsymptoms. With appropriate indications, lamina decompression is a simple and effective surgical method,which also retainsthe spinal movement function.