伴有或无人工椎板重建术的椎管减压术治疗腰椎管狭窄症比较

发布时间：2018-08-23 21:40

【摘要】：[目的]比较腰椎管狭窄症患者行后路全椎板减压内固定,伴有或无人工椎板植入重建的临床疗效。[方法]2013年3月~2015年2月共收治34例采用后路全椎板减压内固定术式的腰椎管狭窄症患者,其中男18例,女16例,年龄48~76岁,平均(56.6±7.2)岁。按是否使用人工椎板重建分为两组,15例行单纯全椎板减压内固定术(单纯减压组),19例行全椎板减压内固定联合人工椎板重建术(重建组),统计两组手术时间和术中出血量,术前、术后1周、末次随访临床症状JOA评分、CT观察人工椎板融合率及椎管矢状径。[结果]单纯减压组间手术时间和术中出血量均明显小于重建组,差异有统计学意义(P0.05),两组术后1周JOA评分较术前显著进步,差异有统计学意义(P0.05),但术后1周两组间JOA评分差异无统计学意义(P0.05);术后1周单纯减压组CT椎管矢状径明显小于重建组,差异有统计学意义(P0.05)。所有患者术后获24~36个月(平均25.6个月)随访,末次随访时单纯减压组JOA评分显著低于重建组,两组间差异有统计学意义(P0.05);末次随访时单纯减压组CT椎管矢状径明显小于重建组,差异有统计学意义(P0.05)。CT示术后3~6个月人工椎板与受体骨接触界面模糊、间隙消失。所有患者均无感染,内固定松动、断裂等并发症。[结论]后路全椎板减压内固定联合人工椎板植入椎管成形治疗腰椎管狭窄症,可防止术后瘢痕粘连入椎管,有效扩大椎管大小,临床效果显著。
[Abstract]:Objective: to compare the clinical effects of posterior total lamina decompression and internal fixation with or without artificial laminectomy in patients with lumbar spinal stenosis. [methods] from March 2013 to February 2015, a total of 34 patients with lumbar spinal stenosis underwent posterior total laminar decompression and internal fixation, including 18 males and 16 females, with an average age of (56.6 卤7.2) years. According to whether artificial lamina reconstruction was used or not, 15 cases were treated with total laminar decompression and internal fixation (simple decompression group) and 19 cases with total laminar decompression and internal fixation combined with artificial lamina reconstruction (reconstruction group). The fusion rate of artificial lamina and the sagittal diameter of vertebral canal were observed by JOA score and CT. [results] the time of operation and the amount of intraoperative bleeding in the simple decompression group were significantly lower than those in the reconstruction group (P0.05). The JOA score of the two groups at 1 week after operation was significantly improved than that before operation. The difference was statistically significant (P0.05), but there was no significant difference in JOA score between the two groups at 1 week after operation (P0.05); the sagittal diameter of CT in the decompression group was significantly smaller than that in the reconstruction group 1 week after operation (P0.05). All the patients were followed up for 24 ~ 36 months (mean 25.6 months). At the last follow-up, the JOA score of the simple decompression group was significantly lower than that of the reconstruction group, and the difference between the two groups was statistically significant (P0.05), and the sagittal diameter of the CT spinal canal in the simple decompression group was significantly smaller than that in the reconstruction group at the last follow-up. The difference was statistically significant (P0.05). Ct showed that the interface between the artificial lamina and the recipient bone was blurred and the gap disappeared 3 ~ 6 months after operation. All patients were free of infection, internal fixation loosening, fracture and other complications. [conclusion] posterior total laminar decompression and internal fixation combined with artificial laminectomy in the treatment of lumbar spinal canal stenosis can prevent postoperative scar adhesion into the spinal canal, effectively expand the size of the spinal canal, and the clinical effect is remarkable.
【作者单位】：江西省赣州市中医院骨科;中国人民解放军武汉总医院骨科;
【分类号】：R687.3

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