保留棘突韧带复合体腰椎管扩大术的早期疗效  

Early clinical outcomes of posterior decompressing laminoplasty with preservation of spinous ligament complex

作　　者：陈宇飞 马炜 彭页 张振宇 厉晓杰 朱澍 杜俊杰 CHEN Yu-fei;MA Wei;PENG Ye;ZHANG Zhen-yu;LI Xiao-jie;ZHU Shu;DU Jun-jie(Department of Orthopaedics, Air ForceMedical Center, Beijing 100142, China)

机构地区：[1]空军特色医学中心骨科,北京100142

出　　处：《中国矫形外科杂志》2019年第9期774-778,共5页Orthopedic Journal of China

基　　金：首都特色临床医学应用发展专项项目(编号:Z161100000116057)

摘　　要：[目的]探讨保留棘突韧带复合体腰椎管扩大减压术与传统椎板减压植骨融合内固定术治疗腰椎管狭窄症的早期疗效。[方法] 2014年12月～2017年12月1～2节段腰椎管狭窄症患者60例,分为两组,每组30例,椎管扩大组采用保留棘突韧带复合体腰椎管扩大减压术,减压融合组采用传统的椎板减压植骨融合内固定术。记录围手术期资料,采用视觉疼痛指数(VAS)腰痛/腿痛评分、Oswestry功能障碍指数(ODI)、连续行走距离、手术满意度等评价疗效。[结果]两组患者均顺利手术,无严重并发症。两组随访6～12月,平均(8.53±2.53)月。椎管扩大组手术时间、手术出血量、术后引流量显著优于减压融合组。随时间延长,两组患者的腰痛VAS、下肢痛VAS和ODI评分均显著减少,而两组患者的连续行走距离均显著增加,不同时间点间差异有统计学意义。术前、术后1周时两组间上述指标差异均无统计学意义,但末次随访时,椎管扩大组在腰痛VAS、ODI评分和连续行走距离方面显著优于减压融合组。末次随访时,患者自我非常满意度椎管扩大组优于减压融合组(86.67%vs 60.00%)。减压融合组平均椎间融合时间为(7.26±1.32)个月,未出现内固定相关并发症;末次随访时,椎管扩大组椎管矢状径及椎管横径较术前明显增大,且差异有统计学意义。两组均未见明显相邻节段退变或病椎间隙变窄。[结论]对于1～2节段无腰椎失稳的腰椎管狭窄症,保留棘突韧带复合体腰椎管扩大减压术比传统椎板减压植骨融合内固定术创伤更小,术后恢复更快,且在术后早期缓解腰痛方面更有优势。[Objective] To compare the early clinical outcomes of posterior decompressing laminoplasty with preservation of spinous ligament complex versus posterior decompressing laminectomy and instrumented fusion for lumbar spinal stenosis(LSS).[Methods] From December 2014 to December 2017, 60 patients treated for one or two levels LSS in our department were divided into two groups equally, including 30 patients who underwent posterior decompressing laminoplasty with preservation of spinous ligament complex(the laminoplasty group), and 30 patients who underwent posterior decompressing laminectomy combined with instrumented fusion(the laminectomy group). The perioperative data were recorded, additionally, visual analogue scale(VAS) for back/leg pain, Oswestry disability index(ODI), continuous walking distance and surgical satisfaction rate were used for evaluation of the clinical consequences.[Results] All patients in the two groups received successful operations without serious complications. The follow-up period lasted for 6~12 months(mean 8.53±2.53 months). The laminoplasty group proved significantly superior to the laminectomy group regarding to operation time, intraoperative blood loss and postoperative drainage. The VAS of back pain, VAS of leg pain and ODI scores significantly decreased, whereas the continuous walking distance significantly increased in both groups as time went. Although no statistically significant differences were noticed in anyone of aforesaid parameters before operation and at 1 week postoperatively, the laminoplasty group proved significantly superior to the laminectomy group in VAS of back pain and ODI score at the latest follow up. In term of patient. satisfaction, the laminoplasty group also proved significantly superior to the laminectomy group at the latest follow up(86.67%vs 60.00%). The mean fusion time in the laminectomy group was(7.26±1.32) months. No complications associated with internal fixation was observed in the laminectomy group. The sagittal diameter and transverse diameter o

关 键 词：腰椎管狭窄症 棘突韧带复合体 椎管成形 椎板切除减压术 

分 类 号：R681.57[医药卫生—骨科学]