两种减压术式治疗腰椎管狭窄症的疗效分析  

Outcomes of two different decompressive techniques for lumbar spinal stenosis

作　　者：李波[1] 张宏其[1] 李劲松[1] 刘少华[1] 高琪乐[1] 胡希恒[1] 林旻中[1] 吴源涛[1] 尹新华[1] 

机构地区：[1]中南大学湘雅医院脊柱外科湘雅脊柱外科中心,湖南长沙410008

出　　处：《中国现代医学杂志》2012年第6期76-79,共4页China Journal of Modern Medicine

基　　金：湖南省社会发展科技支撑计划重点项目(No:2009SK2012)

摘　　要：目的探讨两种不同减压术式治疗腰椎管狭窄症的疗效。方法2003年9月-2009年8月共收治72例腰椎管狭窄症患者，男48例，女24例，年龄54-83岁，平均年龄66．3岁。其中40例采用有限椎板切除椎管减压术（A组），32例采用全椎板切除椎间融合内固定术（B组）。采用JOA评分标准进行疗效评价。对患者术前及末次随访神经功能与自觉症状进行评估并计算改善率，结果进行统计学分析。结果本研究中72例患者得到10-62个月随访，平均37个月。末次随访时JOA评分改善率A组56．6％±30．2％，B组60．5％±22．8％，优良率A组77％，B组81％，两组间无统计学差异（P〈0．05）。术后均未出现椎间隙感染及腰椎失稳并发症。结论有限椎管减压治疗腰椎管狭窄症是一种安全有效的手术方式，与全椎板切除椎间融合内固定术比较在手术创伤、恢复时间和治疗费用方面有更大的优势。[ Objective ] To evluate the clinical efficacy of two different decompressive techniques for lumbar spinal stenosis. [ Methods ] 72 patients with lumbar spinal stenosis, from September 2003 to August 2009 were re- viewed retrospectively, of these, there were 48 males and 24 females with the mean age of 66.3 years （range, 54 to 83 years old）. 42 cases were treated with limited laminectomy alone, while another 32 cases underwent complete laminectomy, fusion and instrumentaion. The clinical outcome （including neurofunction and self-assesment） at pre- operation and final follow-up was analyzed by Japanese Orthopaedic Association（JOA） score assessment, the results were put into statistical analysis. [Results] All patients were followed up for an average of 37 months （range, 10 months to 62 months）. The improvement rate of JOA score at final follow-up for each group was 56.6%＋_30.2% and 60.5%＋_22.8% respectively, with excellent to good rate for each group of 77% and 81% respectively. Which showed no statistical difference among two groups （P 〈0.05）. There was no lumbar intervertebral instability and infection. [Conclusion] Limited laminectomy is a safe and effective procedure for the patient of degenerative lumbar spinal stenosis, which is better than complete laminectomy, fusion and instrumentaion in surgical invasion, hospitalization and costs.

关 键 词：腰椎管狭窄症 减压术 疗效 

分 类 号：R681.5[医药卫生—骨科学]