经椎间孔单侧入路双侧减压融合内固定术治疗腰椎管狭窄症的近期疗效观察

发布时间：2018-05-07 17:12

本文选题：腰椎管狭窄症 + 单侧入路双侧减压　；参考：《中国修复重建外科杂志》2017年05期

【摘要】：目的比较经椎间孔单侧入路双侧减压和双侧棘突旁小切口入路双侧减压并行椎间融合内固定术治疗腰椎管狭窄症的近期疗效,以评估经椎间孔单侧入路双侧减压的临床价值。方法 2014年7月—2015年6月,将符合选择标准的48例拟行椎间融合内固定术的腰椎管狭窄症患者随机分为两组,分别为单侧入路双侧减压组(试验组,24例)和双侧棘突旁小切口入路双侧减压组(对照组,24例)。两组患者性别、年龄、病程、疾病类型、累及节段、合并内科疾病及术前肌酸磷酸激酶(creatine phosphokinase,CPK)水平、疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)等一般资料比较,差异均无统计学意义(P0.05),具有可比性。记录两组患者手术时间、术中出血量、术后引流量、住院时间、并发症发生率;术后1、3、7 d检查CPK水平;术后3、6、12个月定期随访,采用VAS评分及ODI评价临床疗效;随访期间行腰椎X线片或CT检查判断椎间是否达骨性融合。结果两组患者手术时间、术中出血量及住院时间比较,差异均无统计学意义(P0.05);但试验组术后引流量明显少于对照组(t=5.547,P=0.000)。术后1 d试验组CPK水平显著低于对照组(t=3.129,P=0.005),术后3、7 d两组CPK水平比较差异均无统计学意义(P0.05)。两组患者均获随访,随访时间12~24个月,平均17个月。所有患者术后切口均Ⅰ期愈合。试验组术后1例发生心脏衰竭;对照组术中1例发生脑脊液漏、1例发生神经根损伤,术后1例发生肺部感染;两组并发症发生率比较差异无统计学意义(χ~2=0.273,P=0.602)。试验组和对照组分别有1例和2例未达椎间骨性融合,椎间融合率分别为95.8%(23/24)和91.7%(22/24),比较差异无统计学意义(χ~2=0.356,P=0.551)。两组均未出现椎间融合器移位、沉降,未出现断钉、断棒和内固定物松动现象;随访过程中亦未发生邻近节段退变,未出现脊柱侧凸及腰椎矢状曲度改变。术后3、6、12个月两组VAS评分及ODI均较术前显著改善(P0.05);术后3、6、12个月试验组VAS评分及ODI均显著优于对照组(P0.05)。结论对于腰椎管狭窄症,经椎间孔单侧入路双侧减压或双侧棘突旁小切口入路双侧减压并行椎间融合内固定术治疗均可取得良好近期疗效。但前者具有手术创伤小、对椎旁肌损伤小、最大程度保留脊柱后方结构、术后引流量少、患者恢复快、住院时间短等优点。
[Abstract]:Objective to evaluate the clinical value of bilateral decompression via intervertebral foramen unilateral approach and bilateral spinous process approach combined with intervertebral fusion and internal fixation in the treatment of lumbar spinal canal stenosis in order to evaluate the clinical value of bilateral decompression via intervertebral foramen unilateral approach. Methods from July 2014 to June 2015, 48 patients with lumbar spinal stenosis who met the selection criteria were randomly divided into two groups. There were 24 cases of bilateral decompression group (test group) and 24 cases of bilateral decompression group (control group). Sex, age, course of disease, type of disease, involvement segment, level of creatine phosphokinase (creatine phosphokinase), visual analogue scale of pain (VASA) and Oswestry dysfunction index (ODI) were compared between the two groups. The differences were not statistically significant (P 0.05) and were comparable. The operation time, intraoperative bleeding volume, postoperative drainage, hospital stay and complication rate were recorded, CPK level was examined at 1 day and 37 days after operation, followed up for 6 months and 12 months, the clinical efficacy was evaluated by VAS score and ODI. Lumbar X-ray or CT examination was performed during follow-up to determine whether intervertebral fusion was bony. Results there was no significant difference in operation time, intraoperative bleeding volume and hospitalization time between the two groups, but the postoperative drainage volume in the trial group was significantly less than that in the control group. The level of CPK in the trial group was significantly lower than that in the control group on the 1st day after operation, but there was no significant difference in CPK level between the two groups on the 7th day after operation (P 0.05). The patients in both groups were followed up for 12 ~ 24 months (mean 17 months). All the postoperative incisions healed in one stage. There was no significant difference in the incidence of complications between the two groups (蠂 ~ (2 / 2) 0.273 P ~ (0.602), one case of cerebrospinal fluid leakage occurred in the control group, one case of nerve root injury and one case of pulmonary infection occurred after operation (蠂 ~ (2 / 2) 0.273 P ~ (0.602). There were 1 case in the experimental group and 2 cases in the control group without intervertebral osseous fusion. The intervertebral fusion rates were 95.823 / 24 and 91.722 / 24, respectively. There was no significant difference between the two groups (蠂 ~ (2 / 2) 0.356P ~ (0.551). In both groups, there was no displacement, sedimentation, broken nail, broken rod and loosening of internal fixation, and no degeneration of adjacent segment, no sagittal curvature of lumbar spine and scoliosis. The VAS score and ODI of the two groups were significantly improved after 3 and 12 months compared with those of the control group, and the VAS score and ODI in the test group were significantly better than those in the control group at 3 and 12 months after operation (P 0.05). Conclusion for lumbar spinal stenosis, bilateral decompression via unilateral intervertebral foramen approach or bilateral paraspinal small incision approach combined with intervertebral fusion and internal fixation can achieve good short-term results. But the former has the advantages of less trauma, less injury to the paravertebral muscle, maximum preservation of the posterior structure of the spine, less drainage, quick recovery and short hospital stay.
【作者单位】：浙江大学医学院附属邵逸夫医院骨科;金华市人民医院骨科;
【分类号】：R687.32

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