减压联合融合、内固定治疗腰椎管狭窄的近期疗效观察

Observation on the short-term effects of decompression combined with fusion and internal fixation in the treatment oflumbar spinal stenosis

目的观察减压联合融合、内固定治疗腰椎管狭窄（lumbar spinal stenosis,LSS）的近期疗效。方法抽取西安市红会医院接受减压联合融合、内固定治疗的LSS患者35例为联合组,选择同期行单纯减压治疗患者30例为单纯减压组,术后随访12~32个月,比较2组手术时间、术中出血量、临床疗效、术前及末次随访VAS评分、相对椎间隙高度、腰椎前凸角及中文版腰椎管狭窄问卷（CSSS）评分变化,同时统计联合组末次随访邻近节段退变（adjacent segment degenerat ion,ASD）发生率。结果单纯减压组平均手术时间、术中出血量明显低于联合组（P〈0.05）。末次随访单纯减压组治疗优良率,与联合组比较差异无统计学意义（P〉0.05）。末次随访单纯减压组相对椎间隙高度均显著低于联合组,差异有统计学意义（P〈0.05）。2组末次随访VAS评分较术前均明显下降（P〈0.05）;但2组治疗前后腰椎前凸角比较差异无统计学意义（P〉0.05）。联合组末次随访时症状严重程度、术后满意度评分均明显低于单纯减压组（P〈0.05）。联合组发生率为8.57%。结论减压联合融合、内固定治疗腰椎管狭窄中期疗效与单纯减压术类似,但前者在维持较高椎间隙高度、减轻症状严重程度上有明显优势,联合术后随访有ASD发生。

Objective To observe the short-term effects of decompression and fusion combined with internal fixation in the treatment oflumbar spinal stenosis. Methods Thir ty-five patients with lumbar spinal stenosis who under went decompression and fusion combined with internal fixation in Xi’an Red Cross Hospital were included in the combination group. Another thrity cases of patients who underwent simple decompression in the same period were included in the simple decompression group. The patients were followed up for 12 to 32 months after surgery. The operation time, intraoperative blood loss, clinical curative effect, VAS scores before surgery and during the last follow-up, relative lumbar space height, lu mbar lordosis and changes of CSSS scores were compared bet ween the t wo g roups. The i ncidence of ASD i n the combination group was statistically analyzed in the last follow-up. Results The average operation time was much shorter and intraoperative blood loss was much less severe in the simple decompression group than those in the combination group（P〈0.05）. During the last follow-up, the excellent rate in the simple decompression group was not significantly different from that in the combined group（P〉0.05）, the relative lumbar space height of the simple decompression group was significantly lower than that of the combination group（P〈0.05）, and VAS scores of the two groups were significantly lower than those before surgery（P〈0.05）, but there was no significant difference in lumbar lordosis between the two groups before and after treatment（P〉0.05）. In the last follow-up, the severity of symptoms and postoperative satisfaction score in the observation group were significantly lower than those in the simple decompression group（P〈0.05）. The incidence of ASD in the combination group was 8.57%. Conclusion The medium-ter m curative effect of decompression and f usion combined with internal fixation in the treatment oflumbar spinal stenosis is similar to that of simple decompression. However, the former has obvious advantages in maintaining relatively higher lumbar space height and relieving the severity of symptoms,though ASD occurs after combined therapy.