经后路单侧椎板入路双侧减压椎间隙植骨融合内固定改良术治疗退变性腰椎管狭窄症

Effect of modified bilateral decompression intervertebral space bone grafting fusion and internal fixation via posterior unilateral lamina approach for degenerative lumbar spinal stenosis

目的分析经后路单侧椎板入路双侧减压椎间隙植骨融合内固定改良术治疗退变性腰椎管狭窄症(DLSS)的临床效果及其安全性。方法抽取2013年4月至2015年8月收治的62例DLSS患者,依据随机数表法分为两组,各31例。研究组采用经后路单侧椎板入路双侧减压椎间隙植骨融合内固定改良术,对照组行全椎板切除椎间融合椎弓根螺钉内固定术,术后随访1年。比较两组手术情况(手术用时、术中失血量、住院时间)、腰椎椎间融合优良率、手术前后视觉模拟评分法(VAS)、欧式功能障碍指数(ODI)、日本骨科协会评分(JOA)变化情况,统计两组并发症发生率。结果两组患者均获随访1年,无失访。研究组手术用时、术中失血量、住院时间均少于对照组(P均<0.01);腰椎椎间融合优良率(90.32%)高于对照组(67.74%,P<0.05)。术后研究组VAS、JOA评分及ODI均优于对照组(P<0.01,P<0.05)。两组随访期间均未出现明显并发症。结论采用经后路单侧椎板入路双侧减压椎间隙植骨融合内固定改良术治疗DLSS效果显著,可减少手术用时及失血量,缓解患者疼痛感及功能障碍情况,改善机体功能与腰椎椎间融合效果,且安全性较高。

Objective To analyze clinical effect and safety of modified bilateral decompression intervertebral space bone grafting fusion and internal fixation via posterior unilateral lamina approach for degenerative lumbar spinal stenosis （DLSS）. Methods Sixty-two DLSS patients received and cured between April 2013 and August 2015 were selected. The patients were randomly divided into two groups according to random number table method （n = 32 each） ：research group and control group. Modified bilateral decompression intelvertebral space bone grafting fusion and internal fixation via poste- rior unilateral lamina approach was performed in research group. Total laminectomy and interbody fusion with pedicle screw internal fixation was performed in control group. Follow up was performed for 1 year. Operation condition （ operation time, intraoperative blood loss, length of hospitalization）, good/excellent rate of lumbar intervertebral fusion, the changes of visual analogue scale （VAS） scores, Oswestry disability index （ODI） and Japanese orthopaedic association （ JOA ） scores before and after operation and incidence of complications were compared between two groups. Results In both two groups, all the patients were followed up for 1 year, and none of them was loss to follow-up. The operation time, intraoperative blood loss and length of hospitalization in research group were all significantly lower than those in control group（ all P 〈 0.01 ）. The good/excellent rate of lumbar intervertebral fusion in research group was significantly higher than that in control group （90. 32% vs 67.74% ,P 〈0. 05 ）. VAS score, JOA score and ODI after operation in research group were all better than those in control group （ P 〈 0.01, P 〈 0.05 ）. No obvious complications occurred during follow=up period in both two groups. Conclusion Modified bilateral decompression intervertebral space bone grafting fusion and internal fixation via posterior unilateral lamina approach for the treatment of DLSS has remarkable efficacy and the advantages of less operation time and intraoperative blood loss, higher safety and can relieve patients＇ pain feeling and dysfunction, improve organism function and effect of lumbar interbody fusion.