精准减压与全椎板切除减压手术治疗腰椎管狭窄症的疗效对比

Comparison of precise decompression and laminectomy in the treatment of lumbar spinal stenosis

目的探讨全椎板切除减压手术与精准减压手术治疗腰椎管狭窄症(lumbar spinalstenosis,LSS)的疗效优劣。方法收集我院2013-09-2015-09行减压手术治疗的LSS患者76例,依据手术方式将其分为两组:其中行全椎板切除减压手术41例,作为对照组;行精准减压手术治疗35例,作为观察组。对两组患者术后随访2年以上,对比其围手术期指标,以及术前、术后2年的VAS评分、ODI指数和多裂肌损伤情况。结果 (1)与对照组相比,观察组的手术时间较短,术中出血量较少,且术后住院时间明显缩短(P<0.05)。(2)术后2年时,两组患者腰痛、腿痛VAS评分与ODI指数均获显著改善(P<0.05),但观察组术后的腰痛VAS评分显著优于对照组(P<0.05)。(3)两组术前的多裂肌MRI信号等级无显著差异(P>0.05);但观察组术后3级损伤仅占比14.29%,显著低于对照组的34.15%,差异有统计学意义(P<0.05)。结论与全椎板切除减压手术相比,精准减压手术治疗LSS患者的减压效果可靠,可减少术中出血量、缩短住院时间,减轻术后多裂肌的损伤,较好地保留了脊柱后柱结构的完整性。

Objective To evaluate the efficacy of total laminectomy and decompression in thetreatment of lumbar spinal stenosis （LSS）. Methods 76 patients with LSS treated by decompressionsurgery in our hospital from September 2013 to September -2015 were collected,according to theoperation mode, they were divided into two groups： 41 cases underwent laminectomy, 35 cases ascontrol group, and treated with precise decompression surgery, as observation group. The patients inthe two groups were followed up for more than 2 years, and the perioperative indexes, VAS score, ODIindex and the injury of the muscle were measured before and after 2 years. Results （1） comparedwith the control group, the operation time of the observation group was shorter, the amount of bleedingwas less, and the postoperative hospital stay was shortened （P〈0.05）. （2） 2 years after surgery, twogroups of patients with low back pain, leg pain VAS score and ODI index improved significantly （P〈0.05）, but the observation group postoperative low back pain VAS score was significantly better thanthe control group （P〈0.05）. （3） there was no significant difference in MRI signal grade between the twogroups before operation （P〉0.05）, but the grade 3 injury in the observation group accounted for only14.29%, which was significantly lower than that of the control group （34.15%）, and the difference wasstatistically significant （P 〈0.05）. Conclusion compared with laminectomy decompression,decompression effect of precise decompression surgery in the treatment of patients with LSS is reliable,can reduce the amount of bleeding, shorten the hospitalization time, multifidus muscle damage afteroperation, preserve the integrity of the posterior column structure.