椎管减压融合术与椎管减压术治疗腰椎管狭窄临床疗效的前瞻性研究

Prospective study of clinical effect of spinal canal decompression fusion and spinal canal decompression in the treatment of lumbar spinal stenosis

目的验证减压+融合手术与单纯减压手术治疗腰椎管狭窄的临床疗效是否存在差异。方法将228例1-2个节段腰椎管狭窄的患者按照术前是否存在退变性腰椎滑脱,分为融合组和单纯减压组。融合组111例(伴退行性腰椎滑脱67例,不伴者44例)进行椎管减压+椎间融合手术,单纯减压组117例(伴退行性腰椎滑脱66例,不伴者51例)予以单纯椎管减压手术。结果术后随访期间,两组ODI指数评分及6 min行走试验结果无显著性差异(P>0.05)。随访结果分析显示,两组临床效果没有明显差异。平均住院时间:融合组显著长于单纯减压组(P<0.05)。融合组手术时间长,出血量大,手术费用高。融合组中22%的患者进行了翻修手术,单纯减压组有21%的患者进行了翻修手术。结论腰椎管狭窄症患者当中,无论伴或不伴退化性腰椎滑脱,与单纯减压手术相比,减压+融合手术对手术疗效无明显提高效果。

Objective To compare the clinical curative effect of of decompression＋fusion surgery and the simple decompression surgery for lumbar spinal stenosis. Methods According to whether had preoperative degenerative spondylolisthesis, we assigned 228 patients who had lumbar spinal stenosis at one or two adjacent vertebral levels to undergo either decompression surgery plus fusion surgery（fusion group,67 patients with the lumbar spondylolisthesis and 44 patients without the lumbar spondylolisthesis） or decompression surgery alone （decompression-alone group,66 patients with the lumbar spondylolisthesis and 51 patients without the lumbar spondylolisthesis）. Results During the postoperative follow-up, there were no significant differences between the two groups in the Oswestry disability index（ODI） score and the 6 min walking test（P〉0.05）. The clinical effect between the two groups had no significant difference. The average length of hospital stay in the fusion group was significantly longer than the simple decompression group（P〈0.05）. In the fusion group, the operation time was long, the blood loss was high, and the operation cost was high. 22% of the patients in the fusion group underwent revision surgery, and in the simple decompression group, the revision was performed in 21% of patients. Conclusion For patients with lumbar spinal stenosis, with or without degenerative spondylolisthesis, decompression and fusion surgery has no significant improvement in the effect of surgery compared with simple decompression surgery.