植骨固定术与选择性减压术治疗腰椎退行性滑脱症效果比较  

Therapeutic effect of bone graft fixation versus selective decompression on lumbar degenerative spondylolisthesis

作　　者：王祥强 苗峰 卜志勇 

机构地区：[1]湖北医药学院附属人民医院十堰市人民医院脊柱外科,湖北十堰442000

出　　处：《中华实用诊断与治疗杂志》2018年第1期64-66,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：湖北省教育厅科研项目(B2015176)

摘　　要：目的比较腰椎退行性滑脱症患者应用植骨固定术、选择性减压术治疗的效果。方法腰椎退行性滑脱症患者96例,随机分为植骨固定术组51例和选择性减压术组45例,分别行植骨固定术、选择性减压术。记录2组手术时间、术中出血量和住院时间;术后6个月行X线片检查,计算腰椎坚固融合率;术前及术后6个月应用Oswestry功能障碍指数问卷表(Oswstry disability index,ODI)评估腰椎功能,应用视觉模拟评分(visual analogue scale,VAS)评估疼痛程度,应用日本骨科协会(Japanese Orthopedic Association,JOA)评分评估脊髓神经功能,并进行比较。结果选择性减压术组手术时间[(121.24±32.47)min]较植骨固定术组[(182.35±35.61)min]短,术中出血量[(313.58±24.73)mL]较植骨固定术组[(451.27±46.16)mL]少(P<0.05),住院时间[(7.58±3.54)d]与植骨固定术组[(8.34±3.41)d]比较差异无统计学意义(P>0.05);术后6个月,选择性减压术组腰椎坚固融合率(86.67%)高于植骨固定术组(68.63%)(P<0.05);选择性减压术组和植骨固定术组术后6个月ODI评分[(18.62±1.34)、(26.93±2.79)分]、VAS评分[(2.29±0.31)、(3.11±0.26)分]均低于术前[(46.12±3.87)、(45.75±3.64)分;(7.06±0.82)、(7.02±0.79)分],JOA评分[(23.12±2.37)、(17.54±2.11)分]均高于术前[(9.65±0.85)、9.78±0.96)分](P<0.05);选择性减压术组术后6个月ODI评分、VAS评分低于植骨固定术组,JOA评分高于植骨固定术组(P<0.05)。结论与植骨固定术比较,腰椎退行性滑脱症患者应用选择性减压术治疗坚固融合率高,可明显减轻术后疼痛、腰椎功能障碍,改善脊髓神经功能。Objective To compare the clinical effect of bone graft fixation versus selective decompression on lumbar degenerative spondylolisthesis. Methods Ninety-six patients with lumbar degenerative spondylolisthesis were divided into fixation group （r= 5]） and selective decompression group （n= 45）. The operation lasting time, intraoperative blood loss and hospitalization stay were recorded. X ray was performed to calculate the solid fusion rate in 6 months after operation. The lumbar dysfunction index, the degree of pain and the spinal cord neurological function were evaluated by Oswestry disability index （ODI）, visual analogue scale （VAS） and Japanese Orthopedic Association （JOA） score and were compared before and 6 months after operation between two groups. Results The operation lasting time was significantly shorter and the intraoperative blood loss was significantly less in selective decompression group （（121.24 ±32.47） rain, （313.58＋24.73） mL） than those in fixation group （（182.35±35. 61） rain, （451.27±46. 16） mL） （P〈0. 05）, and there was no significant difference in the hospita[ization stay between selective decompression group （（7.58 ± 3.54） d） and fixation group （（8. 34 ~ 3. 41） d） （P〉0.05）. The solid fusion rate was significantly higher in selective decompression group （86.67%） than that in fixation group （68.63%） in 6 months after operation （P〈0.05）. The ODI scores （18.62__＋1.34, 26.93±2.79） and VAS scores （2.29--±0.31, 3.11--0.26） in selective decompression group and fixation group in 6 months after operation were significantly lower than those be{ore operation （46.12~ 3.87, 45.75 ± 3.64; 7.06±0.82, 7.02±0.79）, and JOA scores were significantly higher （23.12±2.37, 17. 54±2.11） than those before operation （9.65±0.85, 9.78±0.96） （P〈0.05）. And the ODI score and VAS score were significantly lower and JOA score was significantly higher in selective decompression group than those in fixati

关 键 词：腰椎退行性滑脱症 选择性减压术 植骨固定术 坚固融合率 

分 类 号：R687.3[医药卫生—骨科学]