有限椎板切除减压与全椎板切除减压椎间融合术治疗腰椎管狭窄症的疗效比较

Comparative Study of Degenerative Lumbar Spinal Stenosis between Limited Laminectomy Interbody Fusion and Standard Laminectomy Interbody Fusion

目的比较有限椎板切除减压椎间融合术与传统全椎板切除减压椎间融合术在治疗腰椎管狭窄症中的临床疗效。方法 60例腰椎管狭窄症患者中30例采用有限椎板切除减压椎间融合术(A组),30例采用传统全椎板切除减压椎间融合术(B组)。观察两组患者手术时间、术中出血量,术后下地活动时间、术后住院时间及并发症的差异。术前、术后随访时分别采用JOA和VAS评分进行相关功能评价。结果两组患者术后JOA评分、腰痛及腿痛VAS评分较术前下降(P<0.05)。两组间比较,患者术后JOA评分改善率差异无统计学意义(P>0.05);而A组患者术后6、12个月的腰痛VAS评分改善率优于B组(P<0.05);A组患者术中出血量、术后下地时间及住院时间少于B组(P<0.05)。结论两种手术方法在治疗腰椎管狭窄症方面均有较好的效果;有限椎板切除减压椎间融合术治疗下腰痛效果优于全椎板切除减压椎间融合术,掌握好手术适应症,是一种安全有效的手术方式。

Objective To comp are the clinical outcomes in lumbar spine stenosis patients treated between limited laminectomy and interbody fusion and traditional standard laminectomy and interbody fusion.Methods 60 patients with lumbar spinal canal stenosis were divided into two groups 30 with limited laminectomy and 30 with standard laminectomy.The operation time,amount of blood loss,postoperative down time,length of hospital stay time postoperation,complications were compared between groups.All patients underwent preoperative,postoperative,and follow-up evaluations with Japanese Orthopedic Association(JOA),visual analogue scores(VAS)for back and leg pain.The minimum length follow-up for two groups was 1 year.Results The postoperative JOA scores of both groups were increased significantly than preoperative scores(P<0.05).The postoperative VAS score of both groups were significantly decreased than preoperative scores(P<0.05).There was no significal difference in JOA score between the two groups(P>0.05).And at 6th month and 12th month after surgery,lumbar pain VAS score in group A was better significantly than that in group B.The operation time,blood loss,postoperative down and hospitalization time in group A were much smaller than those in group B.Conclusion Both limited laminectomy and standard laminectomy are effective in lumbar spine stenosis surgery.However,the improvement of low back pain after limited laminectomy was significantly better than that after standard laminectomy because of small trauma,less blood loss and shorter hospitalization time.So the limited laminectomy and interbody fusion is a safe and effective operation method only if control the indication of operation better.