棘突劈开、单侧进入双侧减压与椎板切除减压治疗退变性腰椎管狭窄症的比较  

Modified unilateral laminotomy for bilateral decompression of lumbar spinal stenosis

作　　者：刘新宇[1] 原所茂[1] 田永昊[1] 郑燕平[1] 王磊[1] 李建民[1] 

机构地区：[1]山东大学齐鲁医院骨科,济南250012

出　　处：《中华骨科杂志》2013年第10期984-989,共6页Chinese Journal of Orthopaedics

摘　　要：目的比较棘突劈开、单侧进入双侧减压与椎板切除、椎管减压治疗腰椎管狭窄症的疗效。方法前瞻性研究2009年6月至2010年5月手术治疗56例退变性腰椎管狭窄症或椎管狭窄合并间盘突出患者资料。术前随机将患者分为棘突劈开、单侧进入双侧减压组（简称棘突劈开组）及传统腰椎椎板切除、椎管减压组（简称椎板切除组）。棘突劈开组共27例，男15例，女12例；年龄49-71岁，平均59．4岁。椎板切除组29例，男18例，女11例；年龄52-69岁，平均61．1岁。术后第3天行血肌酸激酶测定。应用日本矫形外科学会（Japanese Orthopaedic Associaion，JOA）腰痛评分及疼痛视觉模拟评分（visualanaloguescale，VAS）作为手术前后主、客观评分标准。术后6个月CT扫描评价棘突愈合情况。测量术前及末次随访时多裂肌MR面积。结果棘突劈开组21例、椎板切除组24例获得2年以上有效随访。棘突劈开组术前腰痛及下肢痛VAS、JOA评分、多裂肌MR面积分别为：（5．6±1．7）分、（7．1±0．4）分、（11．6±2．6）分、（5．8±1．8）cm^2；椎板切除组分别为（6．2±1．2）分、（7．9＋1．3）分、（10．9±1．0）分、（6．1±2．0）cm^2。棘突劈开组术后第3天血肌酸激酶测定值明显小于椎板切除组。棘突劈开组术后6个月随访时劈开棘突均完全愈合。末次随访时棘突劈开组下肢痛VAS、JOA评分及改善率分别与椎板切除组比较均无显著性差异。棘突劈开组腰痛VAS评分、多裂肌萎缩比分别为（1．0±0．5）分、6-4％±1.2％；椎板切除组分别为（2．6±0．7）分、15．7％±3．0％，棘突劈开组均优于椎板切除组。两组动力位X线片均未见继发性腰椎不稳。结论棘突劈开、单侧进入双侧减压可有效减少手术创伤及术后腰痛发生率，保护双侧多裂肌棘突止点及对侧多裂肌在椎板的附着点。Objective To describe the technique and therapeutic effect of modified unilateral laminotomy for bilateral decompression （M-ULBD） for lumbar spinal stenosis （LSS）. Methods A total of 56 patients with LSS were randomly divided into group A and B. The 27 patients in group A （15 males and 12 females, with an average age of 59.4 years） underwent M-ULBD. The other 29 patients in group B （18 males and 11 females, with an average age of 61.6 years） received conventional laminecto- my. JOA score of low back pain, VAS, CPK three days after operation, pre- and post-operative cross-sectional areas of muhifidus were used to evaluate the clinical results. Results A total of 45 patients （21 in group A and 24 in group B） completed 2 years of follow-up. The preoperative VAS of low back pain, leg pain, numbness, JOA score and cross-sectional areas of multifidus were 5.6±1.7, 7.1±0.4, 11.6±2.6, 5.8±1.8 cm2 in group A and 6.2±1.2, 7.9±1.3, 10.9±1.0, 6.1±2.0 cm2 in group B. There was no sig- nificant difference in preoperative data between both groups. The union of split spinous process was observed in all cases 6 months later according to computed tomography. The postoperative CPK was lower in group A. The postoperative JOA and VAS scores in both groups were improved significantly compared with the corresponding preoperative ones. The VAS of leg pain, numbness, JOA score, and JOA recover rate in latest follow-up were 1.3±0.2, 1.5±0.7, 26.7±2.1, 86.1%±3.1% in group A, and 1.7±0.3, 2.0±1.3, 24.3±2.5, 83.6%±6.4% in group B, respectively. All these data have no difference between group A and B. The VAS of low back pain and atrophy rate of muhifidus were 1.0±0.5, 6.4%±1.2% in group A, and 2.6±0.7, 15.7%±3.0% in group B respectively. All these data are lower in group A. Conclusion Our two years follow-up shows that this method is efficient for lumbar spinal stenosis treatment, however, it still need long term follow-up and to compare with other modified methods.

关 键 词：腰椎 椎管狭窄 减压术 外科 椎板切除术 

分 类 号：R687.3[医药卫生—骨科学]