摘要
目的:探讨椎板节段开窗减压治疗伴Ⅰ度退变性滑脱的腰椎管狭窄症患者的中远期疗效及相关影响因素。方法:回顾分析28例采用单纯椎板减压术治疗的伴Ⅰ度退变性滑脱的腰椎管狭窄症患者,男10例,女18例,年龄45￣75岁,平均62岁,病程4个月￣14年,平均18个月;滑脱节段L425例,L32例,L51例。评估患者术后平均2年与6.8年时的临床疗效。结果:术后平均2年和6.8年的JOA评估优良率分别为89.8%和76%;术前腰痛VAS评分平均7.6分,术后2年及6.8年分别为3.8和5.6分(P<0.05),腿痛VAS评分分别由术前8.2分下降至2.4和2.7分(P<0.01)。影像学检查示滑脱节段椎间高度降低,滑脱轻度增加,椎体间活动度减少,但均无统计学差异。并发症3例,二次手术3例。结论:椎板节段开窗、椎管潜行扩大减压是治疗伴Ⅰ度退变性滑脱的腰椎管狭窄症的一种有效手术方法,远期疗效与手术方法、自然病程进展、相邻节段退变及腰椎不稳等多种因素有关。
Objective：To assess the mid-term and long-term clinical outcome of degenerative lumbar spondylolisthesis with spinal canal stenosis by means of decompressive laminotomy alone.Method：Twenty-eight consecutive patients with degenerative lumbar spondylolisthesis（ Ⅰ°） and spinal canal stenosis were retrospectively reviewed.Patients were treated surgically with decompressive laminotomy alone.Radiographic evaluation was undertaken before and after operation.The clinical outcome was analyzed with a scoring system proposed by Japanese Orthopaedic Association （JOA） score.Result：The mean follow-up period for 25 patients was 6.8 years（ranging from 4 to 12 years）.All patients were available in 2 years follow-up.Clinical outcome of excellent and good was 89.8% and 76% for 2 year and 6.8 year respectively.Preoperative lower limb pain score was statistically decreased at 2 year and 6.8 year follow-up.Preoperative back pain score was also decreased statistically at 2 year follow-up,but reversed at 6.8 year follow-up.There was no significant difference between pre- and post-operative radiographic evidence of spondylolisthesis degree,disc height and sagittal motion.Complications were observed in 3 cases who accepted reoperation.Conclusion：Decompressive laminotomy alone is an effective surgical method in the management of grade Ⅰ degenerative lumbar spondylolisthesis with spinal canal stenosis.Long-term clinical outcome is correlated with surgical technique,progression of natural history, degeneration and post-operative instability of adjacent segment.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
2006年第1期11-14,共4页
Chinese Journal of Spine and Spinal Cord
关键词
退变性脊椎滑脱症
椎板开窗减压术
腰椎管狭窄症
长期随访
Degenerative spondylolisthesis
Decompressive laminotomy
Lumbar canal steonosis
Long term follow-up
