微创单侧入路双侧减压固定与开放双侧减压固定治疗单间隙腰椎管狭窄症的疗效比较  

Comparison of the curative effect of minimally invasive bilateral decompression fixation via unilateral approach and open bilateral decompression fixation in the treatment of single level lumbar spinal stenosis

作　　者：汪翔 卜星平 吴小涛[2] WANG Xiang;BU Xingping;WU Xiaotao(Department of Orthopaedics,Nanjing Jiangning Hospital,Jiangsu ,nanjing ,211100 ,China)

机构地区：[1]南京市江宁医院骨科,211100 [2]东南大学医学院附属中大医院脊柱外科

出　　处：《临床外科杂志》2018年第12期951-954,共4页Journal of Clinical Surgery

摘　　要：目的比较微创单侧入路双侧减压固定与开放性双侧减压固定治疗单间隙腰椎管狭窄症的疗效。方法单间隙腰椎管狭窄病人86例,按随机数字表法分为观察组、对照组两组,每组各43例,分别采用微创单侧入路双侧减压固定与开放性双侧减压固定治疗,比较两组手术及术后恢复情况及术后并发症发生率,采用改良Macnab标准评定手术效果。手术前后均采用疼痛视觉模拟评分表(VAS)、Oswestry功能障碍指数表(ODI)评定病人疼痛程度及腰椎功能改善情况,随访1年,测定术后不同时期病人椎间隙高度指数的变化。结果观察组和对照组切口长度分别为(1. 90±0. 34) cm和(12. 81±2. 41) cm,术中出血量分别为(98. 25±16. 74) ml和(180. 45±20. 26) ml,术后下床活动时间及住院时间分别为(1. 72±0. 36)天、(6. 32±1. 07)天和(2. 81±0. 52)天、(8. 90±0. 96)天,两组比较差异有统计学意义(P <0. 05)。观察组、对照组术后并发症发生率分别为2. 33%和9. 30%,手术疗效分别为90. 70%和86. 05%,差异无统计学意义(P> 0. 05)。两组术后1天、术后3个月VAS评分均降低,观察组和对照组术后1天评分分别为(3. 04±1. 26)分和(3. 91±1. 75)分,差异有统计学意义(P <0. 05)。观察组术后6个月、12个月ODI评分分别为(13. 51±2. 26)分和(10. 79±3. 52)分,对照组分别为(14. 11±3. 23)分和(10. 94±2. 47)分,与术前[观察组术前(32. 14±5. 15)分,对照组术前(33. 31±4. 98)分]比较差异有统计学意义(P <0. 05),组间比较差异无统计学意义(P> 0. 05)。观察组、对照组术后不同时间椎间隙高度指数比较差异无统计学意义(P> 0. 05)。结论微创单侧入路双侧减压固定术治疗单间隙腰椎管狭窄症疗效与开放性双侧减压固定术相当,但创伤小,疼痛轻,同时可缩短病人术后恢复时间,对病人远期脊柱稳定性影响小。Objective To compare the curative effect of minimally invasive bilateral decompression fixation via unilateral approach and open bilateral decompression fixation in the treatment of single level lumbar spinal stenosis. Methods 86 patients with single level lumbar spinal stenosis treated in our hospital during the period were selected as the subjects,and they were divided into the observation group and the control group with 43 cases in each group by the random number table method. The two groups were treated by minimally invasive bilateral decompression fixation via unilateral approach and open bilateral decompression fixation respectively. The situation of operation and postoperative recovery were compared between the two groups,and the incidence of postoperative complications in the two groups was statistically analyzed. The operation effect was evaluated with modified Macnab criteria. The pain degree and improvement of lumbar function were evaluated by the visual analogue scale( VAS) and Oswestry disability index( ODI) before and after operation. A follow-up survey of 1 year was performed,and changes in intervertebral height index at different time after operation were determined. Results The length of incision,intraoperative blood loss,postoperative ambulation time and hospitalization time in the observation group were shorter or less than those in the control group [( 1. 90 ± 0. 34) cm vs( 12. 81 ± 2. 41) cm,( 98. 25 ±16. 74) ml vs( 180. 45 ± 20. 26) ml,( 1. 72 ± 0. 36) d and( 6. 32 ± 1. 07) d vs( 2. 81 ± 0. 52) d and( 8. 90± 0. 96) d ]( P < 0. 05). There was no significant difference in the incidence of postoperative complications or the curative effect of operation between the observation group and the control group( 2. 33% vs 9. 30%,90. 70% vs 86. 05%)( P > 0. 05). VAS scores of the two groups were decreased at 1 day and 3 months after operation,and the VAS score of observation group at 1 day after operation was lower than that of control group [( 3. 04 ± 1. 26) points vs( 3. 91 ± 1. 75) points]

关 键 词：腰椎管狭窄症 单间隙 单侧入路 微创 开放手术 

分 类 号：R687.3[医药卫生—骨科学]