椎板截骨原位回植椎间融合术治疗单节段腰椎退行性疾病疗效分析

Analysis of clinical effects in the treatment of single segment lumbar degenerative disease by lamina osteotomy and former vertebral plates regraft

目的 :比较后路椎板截骨原位回植椎间融合术与椎板全切椎间融合术治疗单节段腰椎退行性疾病的临床疗效。方法:对2010年1月至2014年12月手术治疗的单节段腰椎退行性疾病167例患者的临床资料进行回顾性分析,其中男92例,女75例;年龄45~75(59.6±12.4)岁。167例患者根据不同的手术方式分为椎板回植组(82例)和椎板全切组(85例),对两组患者的一般情况及临床结果进行分析,其中一般情况包括手术时间、术中失血量、术后引流量、住院时间;临床结果包括视觉模拟评分(visual analogue scale,VAS),日本骨科协会(Japanese Orthopedic Association,JOA)评分,Oswestry功能障碍指数(Oswestry Dability Index,ODI),影像学资料,Mac Nab结果以及术后硬膜外纤维化(epidural fibrosis,EF)和相邻节段退变(adjacent segment degeneration,ASD)发生率。结果:所有患者获得随访,时间18~36个月,平均(24.8±5.7)个月,且两组患者的随访时间差异无统计学意义。两组患者的手术时间、术中失血量、术后引流量、住院时间差异无统计学意义。椎板回植组末次随访时VAS、ODI指数及JOA评分分别为(2.0±1.1)分、(24.0±1.8)%、(19.8±8.2)分,椎板全切组分别为(2.5±1.6)分、(23.3±2.0)%、(22.5±8.5)分,两组差异有统计学意义(P<0.05)。按照Mac Nab标准,椎板回植组优59例,良20例,可3例;椎板全切组优47例,良26例,可12例;两组差异有统计学意义(P<0.05)。椎板回植组16例出现EF,发生率为19.51%;椎板全切组30例,发生率为35.29%;两组差异有统计学意义(P<0.05)。椎板回植组出现20例ASD,发生率为24.39%;椎板全切组出现37例,发生率为43.53%;两组差异有统计学意义(P<0.05)。结论:椎板截骨回植术与椎板全切术治疗单节段腰椎退行性疾病均可取得理想的临床效果,而椎板截骨回植术保留了脊柱后方韧带复合体的完整性,术后EF和ASD发生率低,是一种较好的手术方式。

Objective：To compare the clinical effect between the lamina osteotomy and former vertebral plates regraft method and total laminectomy and interbody fusion method in treating single segment lumbar degenerative disease. Methods：The clinical data of 167 patients with single segment lumbar degenerative disease underwent surgical treatment from January2010 to December 2014 were retrospectively analyzed. There were 92 males and 75 females,aged from 45 to 75 years old with an average of（59.6±12.4） years. The patients were divided into lamina osteotomy and former vertebral plates regraft group（82 cases） and total laminectomy and interbody fusion group（85 cases） according to the different surgical methods used. The general conditions and clinical effects were compared between two groups. General conditions included the operation time,intraoperative blood loss,postoperative drainage,hospitalization time and the clinical effects included the visual analogue scale（VAS）,Japanese Orthopaedic Association（JOA）,Oswestry Dability Index（ODI）,Mac Nab results,epidural fibrosis（EF）,the incidence of adjacent segment degeneration（ASD）. Results：All the patients were followed for 18 to 36 months with an average of（24.8±5.7） months,furthermore,there was no significant difference in the follow up time between two groups. There was no significant difference in general conditions such as operation time,intraoperative blood loss,postoperative drainage,or hospitalization time between two groups. At final follow up,the VAS,ODI,JOA,of all patients were significantly improved（P〈0.05）;and the three factors above in the lamina osteotomy and former vertebral plates regraft group respectively were（2.0±1.1）points,（24.0 ±1.8） %,（19.8 ±8.2） point,while the results of total laminectomy and interbody fusion group were（2.5 ±1.6）points,（23.3±2.0）%,and（22.5±8.5） point;there was statistical difference between two groups（P〈0.05）. According to the standard of Mac Nab,59 cases obtained excellent results,20 good,3 fair results in the lamina osteotomy and former vertebral plates regraft group;while 47 cases got excellent results,26 good,and 12 fair results in the total laminectomy and interbody fusion group;there was significant difference between two groups（P〈0.05）. Sixteen patients（19.51%） with EF and 20 patients（24.39%） with ASD were found in lamina osteotomy and former vertebral plates regraft group;and 30 patients（35.29%） with EF and 37 patients（43.53%） with ASD were found in total laminectomy and interbody fusion group;there was significant difference between two groups（P〈0.05）. Conclusion：Both two methods can achieve the ideal effects for the treatment of single segment lumbar degenerative disease,but the lamina osteotomy and former vertebral plates regraft method can reserve the integrity of posterior ligamentous complex,reducing the incidence of EF and ASD,and is a better surgical method.