椎板切除减压椎弓根螺钉内固定联合椎体间植骨融合治疗腰椎管狭窄症

Partial Laminectomy Decompression Combined with Pedicle Screw Fixation and Using Local Decompression Bone For Intervertebral Fusion in the Treatment of Single,Double or Multi-Levels Lumbar Stenosis

目的探讨经腰椎后路椎板切除减压椎弓根螺钉内固定联合椎体间植骨融合腰椎管狭窄的临床疗效。方法回顾性分析2006年1月至2013年6月在我院诊断为退变性腰椎管狭窄症的52例患者,男28例,女24例,平均年龄（65±5.64）岁;按单、双及多节段分为3组,单节段23例;双节段13例;多节段16例。术中经腰椎后路切除大部椎板及黄韧带,保留上1/3椎板,据狭窄的部位,彻底减压中央管、神经根管,从症状侧切除椎间盘,处理上下终板,将切除的棘突、椎板及关节突等修整成颗粒骨植于椎体间并置入规格合适的椎间融合器,行椎弓根螺钉内固定。所有患者术后随访时间12~36月,平均26月,术前及末次随访时采用视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）评价临床疗效,通过腰椎X线片测量手术前后腰椎前凸度、受累椎间隙角度及椎间高度观察植骨融合状况。结果术后末次随访单、双及多节段腰椎管狭窄病人VAS、ODI无显著性差异（P〉0.05）,3组间骨融合率无显著性差异（P〉0.05）,多节段组腰椎前凸度、受累椎间隙角度及受累椎间高度与前两组相较有显著性差异（P〈0.05）,与术后3 d相比多节段组融合节段椎间隙角度减小,椎间高度降低。结论椎板切除减压及应用局部减压骨联合椎间融合器行椎体间植骨融合椎弓根螺钉内固定术是治疗腰椎管狭窄症的有效方法,局部减压骨在单、双及多节段的椎体间融合术中效果可靠。

Objective To investigate the clinical effect of partial Laminectomy decompression combined with pedicle screw fixation and using local bone for intervertebral fusion for the treatment of single ,double or-multi - levels lumbar stenosis .Methods From January 2 0 0 6 to June 2 0 13 ,5 2 cases were diagnosed with degen -erative lumbar spinal stenosis ,including 28 males and 2 4 females ,the age from 4 5 to7 6 years old ,with an aver-age of 6 0 years .There were 2 3 cases with one level ,1 3 cases with two levels ,1 6 cases with three or more than three levels .All the operations were done by the same surgeon .For every segment ,about two thirds lamina was resected .The centralcanal and nerve root canal were decompressed completely according to preoperation plan , then resecting the disc from the symptatic side ,the local bone including resected spinous processes ,lamina and articular processes weretrimmed to morselized bone （about 3 mm in diameter）for intervertebral bone grafting and inserting pedicle screw which were done sucessively .All patients were followed up from 1 2 to3 6 months with the mean time of 2 6 months .During the preoperation and the final follow - up visual analogue scale （VAS） ,Os-westry dysfunction index （ODI） were used as value standard .Pre and post operation through x - ray were done to measure lumbar lordosis ,intervertebral angle degrees and middle intervertebral hight and the SUK method was used as standard to evaluate bone fusion .Results Among the three groups in the final follow - up ,VAS , ODI had no significant difference （P 〉 0 .0 5 ） ,Bone fusion rate of all three groups had no significant difference （P〉 0 .0 5 ） ;There was significant difference（P 〈 0 .0 5 ）between the third group and the first two groups in lumbar lordosis degrees ,intervertebral angle degrees and middle intervertebral hight .Middle intervertebral hight nar-rowered and intervertebral angle degrees reduced in multi - levels intervertebral fusion comparing with 3 days af-ter Surgery .Conclusion Partial laminectomy decompressioncombined with pedicle screw fixation and using local decompression bone for intevertebral fusion is an effective method in the treatment of lumbar spinal stenosis .Lo-cal bone for intervertebral fusion in single ,double or multi - levelswas reliable .Compared with 3 days after Surgery middle intervertebral hight significantly narrower in multi - levels intervertebral fusion ,which has less effects in keeping intervertebral height .