有限椎板切除减压术和全椎板切除减压术治疗退行性腰椎管狭窄症的疗效比较

发布时间：2018-04-12 14:47

本文选题：腰椎管狭窄 + 有限椎板切除　；参考：《广西医科大学》2015年硕士论文

【摘要】：目的比较有限椎板切除减压术和全椎板切除减压术在治疗退行性腰椎管狭窄症的近期疗效。方法回顾性分析2011年11月至2014年1月收治的退行性腰椎管狭窄症60例,按手术方式分为有限椎板切除减压术组(A组)和全椎板切除减压术组(B组)。分别记录两组的手术时间、术中出血量和住院时间;术后随访采用日本矫形外科学会(Japanese orthopaedic association,JOA)评分系统评估两组术后神经功能恢复情况;通过术前术后影像学资料测量融合节段高度和腰椎前凸角度的变化,同时评估植骨融合程度。结果两组的手术时间与住院天数均无明显差异,但B组的术中出血量明显大于A组,差异有统计学意义(P0.05)。术后60例患者均获得随访,平均随访时间为22.1个月(13~35个月)。两组术后JOA评分均较术前明显增加,差异有统计学意义(P0.05),但组间的JOA评分改善率无明显差异。两组术后融合节段的高度较术前明显增加(P0.05),但术后6个月和术后12个月B组融合节段高度丢失较A组更为明显。术后两组腰椎前凸角度(cobb角)与术前无明显差异。结论有限椎板切除减压术和全椎板切除术两种手术方式在治疗退行性腰椎管狭窄症的早期均可获得满意的临床效果,但有限椎板切除减压术对脊柱的破坏较少,是一种安全有效治疗DLSS的手术方式。
[Abstract]:Objective to compare the short-term efficacy of limited laminectomy and total laminectomy in the treatment of degenerative lumbar spinal stenosis.Methods from November 2011 to January 2014, 60 cases of degenerative lumbar spinal stenosis were retrospectively analyzed and divided into two groups: group A (treated with limited laminectomy and decompression) and group B (treated with total laminectomy and decompression).The time of operation, the amount of blood lost during operation and the time of hospitalization were recorded, and the postoperative neurological recovery was evaluated by Japanese orthopaedic association (JOAA) scoring system.The height of fusion segment and the angle of lumbar kyphosis were measured before and after operation, and the degree of bone graft fusion was evaluated.Results there was no significant difference in operation time and hospital stay between the two groups, but the amount of intraoperative bleeding in group B was significantly larger than that in group A (P 0.05).All the 60 patients were followed up, the average follow-up time was 22.1 months (13 ~ 35 months).The JOA scores of the two groups were significantly higher than those of the preoperative ones, and the difference was statistically significant (P 0.05), but there was no significant difference in the improvement rate of the JOA scores between the two groups.The height of fusion segment in both groups was significantly higher than that before operation, but the loss of fusion level in group B was more obvious than that in group A at 6 months and 12 months after operation.There was no significant difference in lumbar kyphosis angle between the two groups.Conclusion both limited laminectomy and total laminectomy can obtain satisfactory clinical results in the early stage of treatment of degenerative lumbar spinal stenosis, but limited laminectomy and decompression have less damage to spinal column.It is a safe and effective surgical treatment for DLSS.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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