开放椎弓根螺钉置入联合双侧椎板开窗减压术治疗腰椎管狭窄症并不稳患者的效果观察

Curative Efficacy of Open Pedicle Screw Implantation Combined with Bilateral Decompression via Lumbar Fenestration in Treatment of Patients with Unstable Lumbar Spinal Stenosis

目的观察开放椎弓根螺钉置入联合双侧椎板开窗减压术治疗腰椎管狭窄症(LSS)并不稳患者的效果。方法选择2017年5月—2019年10月在本院行手术治疗的112例LSS并不稳患者,依据手术方式的不同均分为观察组和对照组。对照组行开放椎弓根螺钉内固定术,观察组行开放椎弓根螺钉置入联合双侧椎板开窗减压术。分析2组手术指标、影像学指标及腰椎功能情况,统计术后随访1年内椎体融合及内置物情况。结果观察组切口长度、住院时间均短于对照组,术中出血量、术后引流量少于对照组(P<0.01)。术后6、12个月,2组椎间隙高度、椎间孔高度和腰椎前凸角均较术前改善,且观察组改善程度优于对照组(P<0.05)。观察组术后1年椎体融合率高于对照组(P<0.05)。术后6、12个月,2组JOA评分均升高,Oswestry功能障碍指数评分均降低,且观察组腰椎JOA评分高于对照组,Oswestry功能障碍指数评分低于对照组(P<0.05,P<0.01)。术后1年,2组内置物失败率比较差异无统计学意义(P>0.05)。结论开放椎弓根螺钉置入联合双侧椎板开窗减压术治疗LSS并不稳具有切口小、出血量少、对组织结构破坏小的特点,可解除患者神经压迫,有效实现术后相邻椎体间的骨性融合。

Objective To observe clinical efficacy of open pedicle screw implantation combined with bilateral decompression via lumbar fenestration in treatment of patients with unstable lumbar spinal stenosis(LSS).Methods A total of 112 patients with unstable LSS who had undergone surgery between May 2017 and October 2019 were divided into observation group and control group according to different surgical methods.Control group was treated with open pedicle screw internal fixation,while observation group was treated with open pedicle screw implantation combined with bilateral decompression via lumbar fenestration.Surgical indexes,imaging indexes and lumbar function were analyzed,and conditions of vertebral fusion and implantations within 1 year of postoperative follow-up were counted in two groups.Results In observation group,length of incision and hospital stay were shorter,and volumes of intraoperative bleeding and postoperative drainage were less than those in control group(P<0.01).After operation for 6 and 12 months,the intervertebral space height,intervertebral foramen height and lumbar lordosis angle were improved compared with those before operation in two groups,and the improvement degrees in observation group were better than those in control group(P<0.05).After operation for 1 year,the vertebral fusion rate in observation group was higher than that in control group(P<0.05).After operation for 6 and 12 months,JOA scores were increased,while scores of Oswestry dysfunction index were decreased in two groups;in observation group,JOA score was higher than that in control group,while Oswestry dysfunction index score was lower than that in control group(P<0.05,P<0.01).There was no significant difference in failure rate of implantations after operation for 1 year between two groups(P>0.05).Conclusion Open pedicle screw implantation combined with bilateral decompression via lumbar fenestration in treatment of patients with unstable LSS has characteristics of smaller incision,less bleeding volume and less damage to tissues and structures.It may relieve the nerve compression of patients and effectively promote the bone fusion between adjacent vertebral bodies after operation.