椎管成形术中保留腰椎后柱结构治疗退行性腰椎管狭窄症疗效

Preserving the posterior column structure of lumbar spine in laminoplasty for degenerative lumbar spinal stenosis

目的 探讨椎管成形术中保留腰椎后柱结构对退行性腰椎管狭窄症(DLSS)患者症状改善及血清神经胶质纤维酸性蛋白(GFAP)、亮脑啡肽(LEK)水平的影响。方法 选取2016年8月至2019年7月收治的78例DLSS患者,依据治疗方案分组,各39例。对照组行全椎板切除减压术,观察组采用椎管成形术中保留腰椎后柱结构治疗。比较两组手术一般指标、并发症发生率及手术前后血清GFAP、LEK水平、影像学检查、症状改善情况[视觉模拟评分法(VAS)评分、腰椎功能(JOA)、跛行距离]。结果 观察组滑移距离改变值低于对照组(P<0.01)。观察组术后7 d血清GFAP水平低于对照组低,LEK水平高于对照组(P<0.01)。观察组术后6个月椎管矢状径、盘黄间隙及椎间孔前后径高于对照组(P<0.05,P<0.01)。观察组术后6个月VAS评分低于对照组,JOA评分及跛行距离优于对照组(P<0.05)。两组并发症发生率相比差异无统计学意义(P>0.05)。结论 椎管成形术中保留腰椎后柱结构应用于DLSS患者,能有效维持腰椎稳定性,调节血清LEK、GFAP水平,改善症状,恢复腰椎功能,保证安全性。

Objective To investigate the effect of preserving the posterior column structure of lumbar vertebrae on the improvement of symptoms and the levels of glial fibrillary acidic protein(GFAP) and leucine enkephalin(LEK) in patients with degenerative lumbar spinal stenosis(DLSS).Methods A total of 78 patients with DLSS from August 2016 to July 2019 were selected and divided into groups according to the treatment scheme(n=39,each).The control group was treated with total laminectomy and decompression,and the observation group was treated with the preservation of posterior column structure during laminoplasty.The general indexes,incidence of complications,serum GFAP,LEK levels,imaging examination,symptom improvement [visual analogue scale(VAS),Japanese Orthopaedic Association Score(JOA),claudication distance]were compared between the two groups.Results The change of slip distance in the observation group was significantly lower than that in the control group(P<0.05).Compared with the control group,the serum GFAP level was lower and LEK level was higher in the observation group 7 days after operation(P<0.01).The sagittal diameter of spinal canal,intervertebral disc yellow space and anterior and posterior diameter of intervertebral foramen in the observation group were higher than those in the control group 6 months after operation(P<0.05,P<0.01).The VAS score of the observation group was lower than that of the control group at 6 months after operation,and the JOA score and claudication distance of the observation group were better than those of the control group(P<0.01).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion Keeping the posterior column structure in laminoplasty can effectively maintain the stability of lumbar spine in patients with DLSS,regulate the levels of serum LEK and GFAP,improve symptoms,restore lumbar function and ensure safety.