单纯椎板减压术与减压融合内固定术治疗退行性腰椎管狭窄症的疗效比较

Efficacy comparison of simple laminectomy and decompression fusion and internal fixation for degenerative lumbaRspinal stenosis

目的比较单纯椎板减压术与减压融合内固定术治疗退行性腰椎管狭窄症(DLSS)的疗效。方法将170例DLSS患者根据治疗方法不同分为观察组(采用单纯椎板减压术治疗,85例)与对照组(采用减压融合内固定术治疗,85例)。比较两组手术前后的脊柱矢状面平衡参数[骨盆投射角(PI)、骶骨倾斜角(SS)、骨盆倾斜角(PT)、腰椎前凸角(LL)、胸后凸角(TK)]、ZCQ评分、疼痛VAS评分、JOA评分、ODI评分。结果患者均获得1年随访。PT、LL、TK:术后1年两组均较术前升高(P<0.05),观察组均高于对照组(P<0.05);SS、PI:术后1年两组与术前比较差异均无统计学意义(P>0.05),两组间比较差异均无统计学意义(P>0.05)。ZCQ评分中的症状严重程度、身体机能评分术后1年两组均较术前降低(P<0.05),满意度两组比较差异无统计学意义(P>0.05)。疼痛VAS评分、ODI评分术后1年两组均较术前降低(P<0.05),JOA评分术后1年两组均较术前升高(P<0.05)。ZCQ评分、疼痛VAS评分、ODI评分、JOA评分术后1年两组间比较差异均无统计学意义(P>0.05)。结论单纯椎板减压术治疗DLSS的临床疗效与减压融合内固定术相似,能够有效改善脊柱矢状面平衡。

Objective To compare the effects of simple laminectomy and decompression fusion and internal fixation on degenerative lumbaRspinal stenosis(DLSS).Methods The 170 patients were divided into observation group(simple laminectomy,85 cases)and control group(decompression fusion combined with internal fixation,85 cases)according to different treatment methods.The spinal sagittal plane balance parameters[pelvic incidence(PI),sacral slope(SS),pelvic tilt(PT),lumbaRlordosis(LL),thoracic kyphosis(TK)],ZCQ score,pain VAS score,JOA score and ODI score were compared between the two groups before and afteRsurgery.Results All patients were followed up foR1 year.PT,LL and TK in the two groups were increased than those before surgery(P<0.05),and the above indexes of the observation group were all higheRthan the control group(P<0.05).There were no significant differences in SS and PI of the two groups before and 1 yeaRafteRsurgery(P>0.05),and two groups had no differences in the indexes(P>0.05).At 1 yeaRafteRsurgery,the symptom severity and physical function scores in ZCQ scores were decreased than those before surgery(P<0.05),there was no statistical difference in the satisfaction between two groups(P>0.05).At 1 yeaRafteRsurgery,pain VAS and ODI score in the two groups were decreased than those before surgery(P<0.05),while JOA scores in the two groups were higheRat 1 yeaRafteRsurgery than before surgery(P<0.05).There were no significant differences in ZCQ score,pain VAS,ODI score and JOA score between the two groups at 1 yeaRafteRsurgery(P>0.05).Conclusions The clinical effect of DLSS treated by simple laminectomy is similaRto that of decompression fusion and internal fixation surgery,which can effectively improve the sagittal plane balance of the spine.