椎板开窗潜行扩大减压融合内固定对腰椎管狭窄症伴退行性滑脱的效果观察

Effect of laminectomy fenestration decompression fusion and internal fixation on lumbar spinal stenosis complicated with degenerative spondylolisthesis

目的 探讨椎板开窗潜行扩大减压融合内固定对腰椎管狭窄症伴退行性滑脱的效果.方法 随机选取2006年1月至2012年9月收治的腰椎管狭窄症伴退行性滑脱患者65例,按照随机数字表法分为实验组（30例）和对照组（35例）.对照组行椎板开窗潜行扩大减压术,实验组行椎板开窗潜行扩大减压术＋后外侧植骨融合＋椎弓根内固定手术治疗.所有患者均于术后3年内定期跟踪随访,对比两组手术指标、各时刻JOA和ODI评分以及手术优良率.结果 实验组手术时间和术中出血量均较对照组升高（P均〈0.05）,前者住院时间较后者缩短（P〈0.05）;两组术前JOA和ODI评分比较差异未见统计学意义（P均〉0.05）,术后1个月、1年和3年JOA均逐渐升高（P均〈0.05）,ODI均降低（P均〈0.05）,且术后各时刻两样本各组数据比较差异均有统计学意义（P均〈0.05）;实验组优良率（86.67％）较对照组（57.14％）升高（P〈0.05）.结论 采用椎板开窗潜行扩大减压融合内固定治疗腰椎管狭窄症伴退行性滑脱近期效果显著,且可以明显改善预后.

Objective To study the effect of laminectomy fenestration decompression fusion and internal fixation on lumbar spinal stenosis complicated with degenerative spondylolisthesis.Methods From January 2006 to September 2012,65 cases of lumbar spinal stenosis complicated with degenerative spondylolisthesis were randomly selected,who were divided into the experiment group （30 cases） and the control group （35 cases）.The patients in the control group were given laminectomy fenestration decompression,and the patients in the experiment group were given laminectomy fenestration decompression and posterolateral bone fusion and pedicle screw internal fixation operation.All patients were followed up for 3 years after surgery,and the surgical indicators,JOA and ODI scores at all the time,and the excellent and good rates of patients in the two groups were compared.Results The operation time and intraoperative blood loss in the experiment group were significantly higher than those in the control group （both P 〈 0.05）,and the hospitalization time of the former was significantly shorter than that of the latter（P 〈 0.05）.There were no significant differences in JOA or ODI scores between the two groups before operation （both P 〉 0.05）,and the JOA scores in the two groups were significantly higher at 1 month,1 year and 3 years after operation （all P 〈 0.05）,the ODI scores significantly lower （all P 〈 0.05）,and the differences between the two groups at all time after operation were significant （all P 〈 0.05）.The excellent and good rate in the experiment group（86.67%） significantly increased,compared with that in the control group （57.14%） （P 〈 0.05）.Conclusions The recent effect of laminectomy fenestration decompression fusion and internal fixation on lumbar spinal stenosis combined with degenerative spondylolisthesis is significant,which can significantly improve the prognosis.