两种术式治疗退行性腰椎滑脱合并邻近节段椎管狭窄比较

Comparison of two surgical techniques for degenerative lumbar spondylolisthesis combined with adjacent spinal canal stenosis

[目的]比较两种术式治疗退行性腰椎滑脱合并邻近节段椎管狭窄的临床疗效。[方法]回顾性分析本院2017年1月—2018年12月41例退行性腰椎滑脱合并临近节段椎管狭窄患者的临床资料,其中,23例行多节段全椎板减压椎间融合(长节段组),18例行滑脱节段全椎板减压椎间融合合并临近节段开窗减压(短节段组)。比较两组围手术期、随访及影像学资料。[结果]两组所有患者均顺利手术,长节段组的手术时间、术中失血量、术后引流量均显著大于短节段组(P<0.05)。随访时间12~36个月,两组在恢复下地行走和完全负重活动时间的差异无统计学意义(P>0.05)。与术前相比较,末次随访时两组患者腰痛和腿痛VAS评分以及ODI评分显著下降(P<0.05),相应时间点两组间腰痛和腿痛VAS评分以及ODI评分的差异均无统计学意义(P>0.05)。影像学方面,与术前相比,末次随访时两组患者的Meyerding脊柱滑脱分级显著改善(P<0.05),两组患者腰椎前凸角(LL)显著改善(P<0.05);相应时间点,两组间脊柱滑脱分级和LL的差异均无统计学意义(P>0.05)。至末次随访时,两组患者均达到椎间骨性融合,无内置物松动、断裂。[结论]两种术式治疗退行性腰椎滑脱合并邻近节段椎管狭窄均可取得良好的临床效果,相比较之,短节段手术创伤更小。

[Objective] To compare the clinical outcomes of two surgical methods for the treatment of degenerative lumbar spondylolisthesis with adjacent segmental spinal stenosis. [Methods] From January 2017 to December 2018, a total of 41 patients underwent surgical treatment for degenerative lumbar spondylolisthesis combined with adjacent segmental spinal stenosis in our hospital. Among them, 23 patients had multi-segment total laminar decompression and interbody fusion performed(long-segment group), while the remaining 18 patients underwent total laminar decompression and interbody fusion in the spondylolisthetic segment combined with decompression with fenestration on the adjacent segment(short-segment group). The perioperative, follow-up and imaging data were compared between the two groups. [Results] All patients in the two groups were successfully operated. The long-segment group consumed significantly longer operation time, associated with significantly greater intraoperative blood loss and postoperative drainage volume than the short-segment group(P<0.05). The follow-up period lasted for 12~36 months. There was no statistically significant difference between the two groups in the time of resuming walking and full weight-bearing activities(P>0.05). Compared with those preoperatively, the low back pain and leg VAS scores and ODI scores decreased significantly at the latest follow-up in both groups(P<0.05). However, there were no statistical differences in low back pain and leg pain VAS scores, as well as ODI scores between the two groups at any corresponding time point(P>0.05). Regarding to imaging evaluation, the slippage extent in term of Meyerding classification significantly improved at the latest follow-up in both groups compared with those preoperatively(P<0.05), whereas there was significant change in the lumbar lordosis angle(LL) in both groups(P<0.05). At the matching time points, there were no statistically significant differences in the grade of spondylolisthesis and LL between the two groups(P>0.05). To the latest follow-up, bony fusion of involved intervertebral spaces achieved without loosening or breaking of implants in both groups. [Conclusion] Both the surgical techniques have achieved good clinical results for degenerative lumbar spondylolisthesis combined with adjacent segmental spinal stenosis. In comparison, the short segment surgery has less iatrogenic trauma.