摘要
[目的]比较选择性减压融合与多节段减压融合治疗伴退行性滑脱的多节段腰椎管狭窄症的临床疗效。[方法]将2012年1月~2014年1月收治的36例伴有退行性滑脱的多节段腰椎管狭窄症患者随机分为选择性减压融合组（选择组,19例）和多节段减压融合组（多节段组,17例）。选择组仅对引起临床症状的部位进行减压,对术前存在腰椎滑脱或不稳的节段以及术后可能出现失稳的节段予以固定融合。多节段组对影像学所见的狭窄节段均进行充分减压、固定融合。比较两组的年龄、性别、病程、手术时间、失血量、减压节段和融合节段。用JOA、VAS及ODI评分评估临床疗效。随访拍摄腰椎X线片和MRI,观察腰椎稳定性。[结果]所有患者均获得2年以上随访。多节段组的手术时间、失血量及融合节段均大于选择组（P〈0.05）。两组病例术后末次随访的JOA、VAS和ODI评分均较术前改善（P〈0.05）,末次随访的JOA、VAS和ODI评分两组间差异无统计学意义（P〉0.05）。选择组减压未融合节段无医源性失稳表现。[结论]选择性减压融合与多节段减压融合治疗伴退行性滑脱的多节段腰椎管狭窄症疗效相当,选择性减压融合具有手术时间短、失血量少和创伤小等优点。
[ Objective ] To compare the clinical outcomes of selective decompression and fusion for patients with multilevel lumbar stenosis and single - level degenerative spondylolisthesis （MSDS） . [ Methods ] Thirty - six consecutive patients with MSDS, who were admitted to our hospital from January 2012 to January 2014, were divided randomly into selective decompres- sion and fusion group （selective group, n = 19） or multilevel decompression and multilevel fusion group （multilevel group, n = 17） based on a random number list. In the selective group, decompression was only performed on the responsible segments and fusion was only performed on the segments with preoperative spendylolisthesis or instability and probably iatrogenic unstable lev- els. In the multilevel group, decompression and fusion was performed on all the stenotic levels according to radiographic docu- ments. Age, gender, course of disease, operative time, blood loss, involved segments for decompression and fusion were ana- lyzed statistically. Visual analog scale （VAS） scores, Japanese Orthopedic Association （JOA） and Oswestry Disability Index （ODI） were used to assess the preoperative situation and postoperative clinical results. [ Results] The follow- up period was more than 2 years. No differences were observed between the two groups with respect to demographic data. The patients of the two groups had significant improvement of functional results at postoperative follow - up compared to that of pre - peration （ P 〈 0. 05） . However, compared with multilevel group, a significant decrease in operative time, blood loss and fused levels were found in selective group. No significant instability occured at the adjacent segment. [ Conclusion] Selective decompression and fusion and multilevel decompression and fusion provide similar outcomes in patients with MSDS. Selective decompression and fu- sion is relatively minimally invasive, with less operative time and blood loss.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2016年第23期2139-2143,共5页
Orthopedic Journal of China
关键词
选择性减压融合
退行性滑脱
多节段腰椎管狭窄
selective decompression and fusion,degenerative spondylolisthesis, multilevel lumbar stenosis
