精准减压治疗腰椎管狭窄症的疗效研究

Effect of precise decompression in treatment of lumbar spinal stenosis:a comparative analysis

[目的]探讨采用精准椎板减压（精准组）与全椎板切除减压（全切组）手术治疗腰椎管狭窄症疗效的对比研究。[方法]回顾分析了本院2011年1月~2013年1月收治的77例腰椎管狭窄患者的病例资料,其中精准组35例,全切组42例。分别统计其围手术期情况、视觉模拟评分（VAS）、功能障碍指数（Oswestry Disability Index,ODI）、椎旁肌MRI信号改变。[结果]精准组、全切组出血量分别为（189±91）ml/节段、（245±135）ml/节段（P〈0.05）;引流量分别为（215±106）ml/节段、（300±144）ml/节段（P〈0.05）;术后住院时间分别为（4.5±1.6）d,（6.1±2.3）d（P〈0.05）;术后1年腰、腿痛VAS评分与ODI均比同组术前有明显改善（P〈0.05）,对两组术后腰痛VAS评分（1.6±1.0、2.3±0.9）进行比较,差异有统计学意义（P〈0.05）;对两组术后腿痛VAS评分（1.2±0.9、1.1±0.9）进行比较,差异无统计学意义（P〉0.05）;对两组术后ODI指数[（18.0±5.6）%、（21.2±6.8%）]进行比较,差异有统计学意义（P〈0.05）;对术后1年多裂肌MRI信号比较,差异有统计学意义（P〈0.05）。[结论]精准椎板减压能够获得充分的减压疗效,同时保留了脊柱后柱结构的完整,维持术后椎间的稳定性。具有出血少、住院时间短、椎旁肌损伤小等特点。

[Objective] To investigate the effect of precise vertebral lamina decompression and decompression through laminectomy in the treatment of lumbar spinal stenosis via a comparative analysis. [Methods] The clinical data of 77 patients with lumbar spinal stenosis who were admitted to our hospital from January 2011 to January 2013 were analyzed retrospectively. Of all patients,35 underwent precise vertebral lamina decompression（ group A） and 42 underwent decompression through laminectomy（ group B）. The general status,conditions during the perioperative period,Visual Analogue Scale（ VAS）,Oswestry Disability Index（ ODI）,and MRI signal of paravertebral muscle were summarized. [Results] The two groups showed significant differences in blood loss（ 189 ± 91 ml / segment vs 245 ± 135 ml / segment,P〈0. 05）,volume of drainage（ 215 ± 106 ml / segment vs300 ± 144 ml / segment,P〈0. 05）,and length of postoperative hospital stay（ 4. 5 ± 1. 6 days vs 6. 1 ± 2. 3 days,P〈0. 05）.At 1 year after surgery,the two groups showed significant improvements in VAS scores for lumbar and leg pain and ODI（ P〈0. 05）. The VAS score for lumbar pain showed a significant difference between the two groups（ 1. 6 ± 1. 0 vs 2. 3 ± 0. 9,P〈0. 05）,while that for leg pain showed no significant difference between the two groups（ 1. 2 ± 0. 9 vs 1. 1 ± 0. 9,P〉0. 05）.The postoperative ODI also showed a significant difference between the two groups（ 18. 0 ± 5. 6% vs 21. 2 ± 6. 8%,P〈0. 05）.The MRI signal of multifidus muscle at 1 year after surgery showed a significant difference between the two groups（ P〈0. 05）.[Conclusion] Precise decompression can achieve an adequate effect of decompression,reserve the structural integrity of the posterior column,and maintain the spinal stability after surgery,with the features of low blood loss,short hospital stay,and slight injury in paravertebral muscle.