双侧关节突关节切除联合椎弓根固定与椎间融合治疗双侧腰椎椎间孔狭窄症41例

Bilateral facetectomy combined with pedicle screw fixation and interbody fusion in the treatment of bilateral lumbar foraminal stenosis in 41 cases

目的探讨经后路行双侧关节突关节切除术联合椎弓根固定与椎间融合治疗双侧腰椎椎间孔狭窄症(LFS)的临床疗效。方法回顾性分析2010年2月至2013年8月天津市人民医院脊柱外科收治的因双侧LFS行经腰椎后路双侧关节突关节切除术联合椎弓根固定与椎间融合治疗的41例患者,手术前后采用Oswestry功能障碍指数(ODI)及疼痛视觉模拟量表(VAS)进行评分,测量手术前后椎间隙的前高、后高及腰1(L1)~骶1(S1)角,计算末次随访时ODI及VAS评分,椎间隙前高、后高及L1~S1角的变化。结果 41例患者均获得随访,随访时间12~36个月,平均(26.2±2.4)个月。与术前比较,末次随访时腰痛VAS评分、腿痛VAS评分、ODI降低,椎间盘前、后高度增高,差异均有统计学意义(P<0.05);术前与末次随访时L1~S1角比较,差异无统计学意义(P>0.05)。结论经后路行双侧关节突切除术联合椎弓根固定与椎间融合治疗双侧LFS近期临床疗效满意。

Objective To explore the clinical efficacy in bilateral lumbar foraminal stenosis （LFS） after treatment with bilat- eral facetectomy combined with pedicle screw fixation and interbody fusion. Methods A total of 41 cases of patients with bilateral LFS underwent bilateral facetectomy combined with pedicle screw fixation and interbody fusion from February 2010 to August 2013 in Department of Spine Surgery, the People＇s Hospital of Tianjin City, were retrospectively analysed. The clinical efficacy was as- sessed by Oswestry disability index （ODD questionnaire and visual analogue scale （VAS） before and after operation, anterior and posterior disc height and L1- S1 angle were measured as well. Then the ODI and VAS scores, and changes in anterior and posterior disc height and L1 -S1 angle were calculated at the time of the last patient follow-up visit. Results All 41 patients were followed up for 12 to 36 months,with an average of （26.2±2.4） months. Compared with preoperation,at the time of the last follow-up visit the back pain VAS score,leg pain VAS score and ODI were decreased, while the anterior and posterior disc height were increased, there were statistically significant differences （P〈0.05）. No statistically significant difference was found in L1 --S1 angle between preop- eration and postoperation （P〉0.05）. Conclusion The short-term clinical curative effect of posterior bilateral facetectomy com- bined with nedicle screw fixation and interbodv fusion in the treatment of bilateral LFS is satisfactory.