颈椎减压手术治疗以坐骨神经痛为表现的颈腰综合征的临床效果分析

Analyses of clinical outcomes of cervical decompression for patients with tandem spinal stenosis presenting with sciatica-like leg pain

目的分析颈椎减压手术治疗以坐骨神经痛为表现的颈腰综合征（tandem spinal stenosis,TSS）患者的临床效果。方法 2012年1月至2015年6月,我院单行颈椎减压手术治疗12例以坐骨神经痛为表现的TSS患者并进行随访,记录术前、术后3个月及末次随访的疼痛视觉模拟评分（visual analogue scale,VAS）、日本骨科学会（Japanese Orthopaedic Association,JOA）评分、Oswestry功能障碍指数（oswestry disability index,ODI）,并通过患者满意度等方面评价该手术的临床疗效。结果 12例术后均获随访,随访时间4-46个月,平均（21.8±15.5）个月。VAS评分：术前（4.3±1.1）分,术后3个月（2.6±1.1）分,末次随访（1.8±1.1）分;JOA（腰痛）评分：术前（10.5±3.9）分,术后3个月（17.8±4.1）分,末次随访（20.2±5.7）分;ODI：术前（64.6±21.6）,术后3个月（40.2±14.6）,末次随访（31.8±15.3）。VAS、JOA、ODI评分术前、术后3个月和末次随访比较,差异均有统计学意义（P〈0.05）;患者总体满意度为（2.0±1.0）分。结论单行颈椎减压手术治疗以坐骨神经痛为表现的TSS能够明显改善多数患者的相关功能障碍和下肢疼痛症状,避免一期手术引起的不必要手术创伤。

Objective To study the clinical outcomes of cervical decompression for patients with tandem spinal stenosis presenting with sciatica-like leg pain. Methods A total of 12 cases of tandem spinal stenosis presenting with sciatica-like leg pain were treated with cervical decompression, and were followed up from January 2012 to June 2015. Clinical outcomes were evaluated using the visual analogue scale（ VAS） scores, Japanese Orthopaedic Association（ JOA） scores and Oswestry disability index（ ODI） preoperatively, at 3 months after the operation and at the final follow-up. Satisfaction of patients and other indexes were also recorded to evaluate the clinical effects. Results The 12 patients had a follow-up of 4- 46 months, and（ 21.8 ± 15.5） months on average. The VAS scores were（ 4.3 ± 1.1）,（ 2.6 ± 1.1） and（ 1.8 ± 1.1） preoperatively, at 3 months after the operation and at the final follow-up. The JOA scores for back pain were（ 10.5 ± 3.9）,（ 17.8 ± 4.1） and（ 20.2 ± 5.7） preoperatively, at 3 months after the operation and at the final follow-up. The ODI scores were（ 64.6 ± 21.6）,（ 40.2 ± 14.6） and（ 31.8 ± 15.3） preoperatively, at 3 months after the operation and at the final follow-up. The differences of VAS, JOA and ODI scores at the final followup compared with the scores preoperatively and at 3 months after the operation were statistically significant（ P〈0.05）. The average satisfaction was（ 2.0 ± 1.0） points. Conclusions Cervical decompression can dramatically improve functional disturbance and lower extremity pain in most of the patients with tandem spinal stenosis presenting with sciatica-like leg pain, and unnecessary surgical trauma of one-stage operation can be avoided.