摘要
目的 探讨半椎板切除减压术及腰后路减压植骨融合内固定术对于老年多节段腰椎管狭窄症的短中期疗效及两种术式疗效之间的比较.方法 回顾性分析2008年9月～2011年7月新疆医科大学第六附属医院脊柱外科行手术治疗并获得随访的老年性多节段腰椎管狭窄症患者103例,分别予以半椎板切除减压术（减压组,31例）治疗,腰后路减压植骨融合内固定术（融合组,72例）治疗.术后随访24～58个月.在术前、术后6个月、2年随访时,通过中文版腰椎管狭窄问卷（CSSS）量表对患者自身情况的评分,从而比较两种手术方式的疗效.结果 ①所有患者均顺利完成手术.减压组中2例在术后约3年时复发,后行椎间融合手术后好转;其余患者的症状在术后均有缓解.②减压组手术时间[（69±21） min]、术中出血量[（165±50）mL]均低于融合组[（152±27）min、（550±230）mL],差异均有统计学意义（P＜0.05）.③两组间术后6个月、2年症状严重程度、生理功能评分均明显低于组内术前水平,差异均有统计学意义（P＜0.05）.两组间术后6个月CSSS评分的症状严重程度评分、生理功能评分、术后满意程度评分比较,差异均无统计学意义（P＞0.05）;术后2年融合组CSSS评分中症状严重程度、术后满意度评分均低于减压组,差异均有统计学意义（P＜0.05）;术后2年两组生理功能评分比较,差异无统计学意义（P＞0.05）.④减压组术前椎间孔高度与术后6个月比较,差异无统计学意义（P＞ 0.05）;融合组术前椎间孔高度与术后6个月比较,差异有统计学意义（P＜0.05）.结论 与半椎板切除减压术相比较,腰后路减压植骨融合内固定术更有利于症状缓解,获得更好的术后满意度,是治疗老年性多节段腰椎管狭窄症的有效且可靠的方法.
Objective To study effect comparison of the posterior lumbar decompression fusion with internal fixation and the half laminectomy for senile multi-segmental lumbar spinal stenosis.Methods All 103 patients with senile multi-segmental lumbar spinal stenosis,from September 2008 to July 2011,in Department of Spinal Surgery,the 6th Affiliated Hospital of Xinjiang Medical University,were given the surgical treatment and followed up for more than two years,these clinical data were retrospectively analysed.31 patients given half laminectomy were selected as decompression group; 72 patients given posterior lumbar decompression and fusion with internal fixation were chosen as fusion group.The Chinese swiss spinal stenosis questionnaire （CSSS） scale was used to compare the efficacy of two groups at the preoperative,postoperative 6 months and 2 years.Results ①Operations of all patients were successful,2 patients in decompression group relapsed 2 years after operation were found,and they felt better after given posterior lumbar decompression and fusion with internal fixation,the other patients felt anesis after the first operation.②The operation time,intraoperatve blood soss in decompression group [（69±21） min,（165±50） mL] were all lower than those in fusion group [（152±27） min,（550±230） mL],differences were statistically significant （P 〈 0.05）.③Symptom severity,physiological function score between the two groups 6 months,2 years after the operation were all lower than those before the operation,differences were statistically significant （P 〈 0.05）.The differences of symptom severity score,physiological function score and postoperative satisfaction score between the two groups 6 months after the operation were not statistically significant （P 〉 0.05）; the symptom severity score,postoperative satisfaction score in decompression group 2 years after the operation were all lower than those in fusion group,differences were statistically significant （P 〈 0.05）; the differences of physiological function score between the two groups 2 years after the operation were not statistically significant （P 〉 0.05）.④The difference of height of intervertebral foramen in fusion group between the pre-operation and 6 months post-operation was not statistically significant （P 〉 0.05）; the difference of height of intervertebral foramen in decompression group between the pre-operation and 6 months post-operation was statistically significant （P 〈 0.05）.Conclusion Posterior lumbar decompression and fusion with internal fixation is better than half laminectomy in relief of symptom and postoperative satisfaction.It is an effective and reliable method to treat senile multi-segmental lumbar spinal stenosis.
出处
《中国医药导报》
CAS
2014年第6期155-158,166,共5页
China Medical Herald
