微创单侧固定双侧减压在单节段腰椎管狭窄症患者中的效果分析

Effect of minimally invasive unilateral pedicle screw fixation and bilateral decompression on lumbar spinal isolated segment stenosis

目的探讨微创单侧固定双侧减压在单节段腰椎管狭窄症患者中的临床效果。方法选取2014年4月—2016年3月于武警浙江省总队杭州医院进行手术治疗的单间隙腰椎管狭窄症患者91例,其中行微创单侧固定双侧减压的47例患者作为观察组,行开放双侧固定双侧减压的44例患者作为对照组,所有患者随访时间超过1年。比较2组患者手术时间、术中出血量、术后引流量、术后至下地时间、住院时间、手术前后Oswestry功能障碍指数(ODI)、视觉疼痛模拟评分(VAS)以及腰椎融合情况。结果观察组患者手术时间、术中出血量、术后引流量、术后至下地时间、住院时间均明显少于对照组(P<0.05);2组患者手术1年后ODI指数均较手术前显著降低(P<0.05),但2组间ODI指数差异无统计学意义(P>0.05);2组患者手术1年后腿部、腰部VAS评分均较手术前显著降低(均P<0.05),但2组间腿部、腰部VAS评分差异无统计学意义(均P>0.05);Bridwell椎间融合评价结果显示,观察组Ⅰ级31例,Ⅱ级16例,对照组Ⅰ级27例,Ⅱ级17例,2组间差异无统计学意义(P>0.05)。结论微创单侧固定双侧减压治疗单节段腰椎管狭窄症患者疗效满意,且微创单侧固定双侧减压治疗创伤小、恢复快。

Objective To investigate the effect of minimally invasive unilateral pedicle screw fixation and bilateral de- compression in the treatment of single level lumbar spinal stenosis. Methods Total 91 cases of single level lumbar spinal stenosis in our hospital between April, 2014 and March, 2016 were divided into observation group （47 cases） and control group （44 cases）. The patients in the observation group were treated with minimally invasive unilateral pediele screw fixation and bilateral decompression, while control group with open bilateral fixation and bilateral decompression. All patients were followed up for more than one year. The operation duration, intraoperative blood loss, postoperative drainage flow volume, the time from the end of operation to post-operative ambulation, length of hospital stay, Oswestry disability index （ ODI ） , visual analogue scale （ VAS ） and lumbar fusion situation were compared between the two groups. Results The operation duration, intraoperative blood loss, postoperative drainage flow volume, the time from the end of operation to post-operative ambulation and length of hospital stay in the observation group were significantly less than those in the control group （ P 〈 0. 05 ） ; Compared with the data before operation, ODI decreased significantly in both groups at 1 year after the operation （ P 〈 0.05 ） , and ODI had no significant difference between the two groups at 1 year after the operation （ P 〉 0.05 ） ; Compared with pre-operative data, VAS of leg and waist decreased significantly in both groups at 1 year after the operation （ allP 〈 0.05 ） , and VAS of leg and waist had no significant difference between the two groups at 1 year after the operation （ allP 〉 0. 05 ） ; Evaluation of Bridwell intervertebral fusion showed that, class I of the observation group was 31 cases, class Ⅱ was 16 cases, and class I of the control group was 27 cases, class 11 was 17 cases, there was no significant difference between the two groups at 1 year after the operation （ P 〉 0. 05 ）. Conclusion Minimally invasive unilateral pedicle screw fixation and bilateral decompression has satisfactory efficacy, and mild trauma, rapid recovery in patients with single level lumbar spinal stenosis.