椎板切除减压联合植骨融合与椎弓根内固定手术治疗腰椎管狭窄症疗效观察

Effect of laminectomy and decompression combined with bone graft fusion and pedicle internal fixation in the treatment of lumbar spinal stenosis

目的观察椎板切除减压联合植骨融合与椎弓根内固定手术治疗腰椎管狭窄症患者的疗效。方法选择2016年3月至2018年3月镇巴县人民医院收治的腰椎管狭窄症患者80例作为研究对象,采用随机数表法将患者分为对照组和观察组,每组40例。对照组给予单纯椎板切除减压术治疗,观察组给予椎板切除减压联合植骨融合与椎弓根内固定手术治疗。比较两组患者围手术期的手术时间、术中出血量、住院时间;术后随访6个月,比较两组患者术前、术后6个月的视觉模拟评分(VAS)、日本矫形外科协会(JOA)评分、简明健康测量量表(SF-36)生活质量评分以及术后6个月的并发症发生情况。结果观察组患者的治疗优良率为95.0%,明显高于对照组的80.0%,差异有统计学意义(P<0.05);观察组和对照组患者围手术期的手术时间[(121.12±24.27) min vs(147.35±26.34) min]、术中出血量[(347.36±31.42) m L vs (393.25±46.25) mL]、住院时间[(11.81±3.73) d vs (17.16±4.82) d]比较差异均具有统计学意义(P<0.05);术前,两组患者的腰痛VAS评分和JOA评分比较差异均无统计学意义(P>0.05);术后6个月,观察组患者的JOA评分为(12.53±3.27)分,明显高于对照组的(9.48±2.56)分,VAS评分为(2.14±0.83)分,明显低于对照组的(3.59±0.94)分,差异均具有统计学意义(P<0.05);术前,两组患者的SF-36生活质量评分比较差异均无统计学意义(P>0.05);术后6个月,观察组和对照组患者的社会功能评分[(82.67±5.14)分vs(75.12±4.25)分]、躯体功能评分[(81.65±3.74)分vs (71.24±3.15)分]、角色功能评分[(82.74±5.36)分vs (72.52±3.51)分]、认知功能评分[(83.17±4.52)分vs (73.28±3.25)分]比较差异均有统计学意义(P<0.05);术后6个月,观察组患者的并发症总发生率为5.00%,明显低于对照组的22.50%,差异有统计学意义(P<0.05)。结论椎板切除减压联合植骨融合与椎弓根内固定手术治疗腰椎管狭窄症可有效降低患者的疼痛感,缩短住院时间,减少并发症,提高生活质量,临床治疗效果显著,值得推广应用。

Objective To observe the effect of laminectomy and decompression combined with bone graft fusion and pedicle internal fixation in the treatment of lumbar spinal stenosis. Methods Eighty patients with lumbar spinal stenosis received in Zhenba County People’s Hospital from March 2016 to March 2018 were selected as research objects, which were divided into two groups by random number table method, with 40 people in each group. The control group received simple lamina decompression, and the observation group was treated with laminectomy and decompression combined with bone graft fusion and pedicle internal fixation. The excellent and good rates, operation time, intraoperative blood loss, length of hospital stay in perioperative period were compared. Before operation and 6 months after operation, the Visual Analogue Scale(VAS), the Japan Orthopaedic Association(JOA) score, and the Concise Health Scale(SF-36) quality of life score for the two groups of patients were compared. Results Six months after operation, the excellent and good rate of treatment in the observation group was 95.0%, significantly higher than 80.0% in the control group(P<0.05). The operation time, intraoperative bleeding, hospitalization time in perioperative period in the observation group were significantly shorter than those in the control group(P<0.05):(121.12 ± 24.27) min vs(147.35 ±26.34) min,(347.36±31.42) m L vs(393.25±46.25) m L,(11.81±3.73) d vs(17.16±4.82) d. Before operation, there was no significant difference in VAS score and JOA score between the two groups(P>0.05). Six months after operation, the JOA score of the observation group was(12.53±3.27) points, which was significantly higher than(9.48±2.56) points of the control group, and the VAS score was(2.14±0.83) points, which was significantly lower than(3.59±0.94) points in the control group(P<0.05). Before treatment, there was no statistically significant difference in quality of life scores between the two groups(P>0.05). After treatment, the social function score, physical function score, role function score,cognitive function score in the observation group were significantly higher than those in the control group(P<0.05):(82.67±5.14) poinst vs(75.12±4.25) points,(81.65±3.74) points vs(71.24±3.15) points,(82.74±5.36) points vs(72.52±3.51) points,(83.17±4.52) points vs(73.28±3.25) points. Six months after operation, the total incidence of complications in the observation group was 5.00%, which was significantly lower than 22.50% in the control group(P<0.05).Conclusion The treatment of lumbar spinal stenosis with lamina decompression and bone grafting and pedicle screw internal fixation can effectively reduce the pain, shorten the length of hospital stay, reduce complications, and improve the quality of life, with significant clinical treatment effect, which is worth popularizing.