保留腰椎后柱结构椎管成形术与全椎板切除减压术治疗腰椎管狭窄效果比较

Contrastive analysis of lumbar spinal stenosis treated by posterior column conserved laminoplasty and total laminectomy and decompression

目的 对比腰椎管狭窄患者采用保留腰椎后柱结构椎管成形术和全椎板切除减压术治疗的效果.方法 选取2016年1月至2017年5月在运城市中心医院就诊的腰椎管狭窄患者84例,根据随机数字表法分为A组（42例）和B组（42例）.A组采用全椎板切除减压术治疗,B组采用保留腰椎后柱结构椎管成形术治疗,对比两组临床相关指标、视觉模拟评分法（VAS）评分、日本骨科协会评估治疗分数（JOA）评分及并发症发生情况.结果 两组术中出血量、手术时间及术后12个月JOA评分比较差异未见统计学意义（P〉0.05）;B组滑移距离改变值及术后12个月VAS评分均低于A组,差异有统计学意义（P〈0.05）;与术前比较,两组术后12个月JOA评分明显较高,VAS评分较低,差异有统计学意义（P〈0.05）;B组并发症发生率略低于A组,但差异未见统计学意义（P〉0.05）.结论 保留腰椎后柱椎管成形术和全椎板切除减压术均可改善腰椎管狭窄患者腰椎功能,但保留腰椎后柱结构椎管成形术可有效维持腰椎稳定性.

Objective To compare the effects of posterior column conserved laminoplasty and total laminectomy and decompression on patients with lumbar spinal stenosis .Methods Eighty-four patients with lumbar spinal stenosis admitted to Yuncheng Central Hospital from January 2016 to May 2017 were selected and were divided into group A （42 cases） and group B （42 cases） according to the random number table method .Patients in group A were treated by total laminectomy and decompression , and patients in group B were treated by posterior column conserved laminoplasty .The clinically relevant indicators, visual analogue scale （VAS） score, the Japanese Orthopaedic Association （JOA） scores and complications were compared between the two groups .Results There was no statistically significant difference between the two groups in intraoperative blood loss , operative time and JOA score 12 months after surgery （ P〉0.05） .The change of sliding distance and the VAS score at 12 months after operation in group B were significantly lower than those in group A （ P〈0.05 ） .Compared with the preoperative scores, JOA score was significantly higher in the two groups 12 months after surgery , and VAS score was relatively lower , and the difference was statistically significant （ P〈0.05 ） . The incidence of complications in group B was slightly lower than that in group A , but the difference was not statistically significant （ P〉0.05 ） .Conclusions Posterior column conserved laminoplasty and total laminectomy and decompression both can improve lumbar function in patients with lumbar spinal stenosis , but posterior column conserved laminoplasty can effectively maintain lumbar spinal stability .