保留棘上韧带连续性的椎板回植、神经根管扩大术治疗腰椎退变疾病  

Treatment of lumbar degenerative diseases with recapping laminoplasty and nerve root canal′s decompression preserving the continuity of supraspinous ligament

作　　者：李玉伟[1] 王海蛟[1] 崔巍[1] 周鹏[1] 效伟 胡冰涛 李凡 赵世新 温艳[1] Li Yuwei;Wang Haijiao;Cui Wei;Zhou Peng;Xiao Wei;Hu Bingtao;Li Fan;Zhao Shixin;Wen Yan(Department of Orthopedics,Luohe Central Hospital,Luohe 462000,China)

机构地区：[1]漯河市中心医院骨科,漯河462000

出　　处：《中华医学杂志》2021年第9期641-646,共6页National Medical Journal of China

摘　　要：目的探讨保留棘上韧带连续性的椎板回植、神经根管扩大术治疗腰椎退变疾病的临床疗效。方法回顾性分析2016至2018年漯河市中心医院行手术治疗的腰椎退变疾病患者的资料,根据手术方式的不同分为两组。采用超声骨刀行保留棘上韧带连续性的椎板回植、腰椎间盘切除、神经根管扩大术的为治疗组(17例),采用全椎板切除、神经根管扩大、椎间盘切除、椎间融合内固定术(PLIF)的为对照组(28例)。所有患者术后平均随访17.8个月(12~27个月)。应用日本骨科协会(JOA)腰痛29分评分标准和疼痛视觉模拟评分(VAS)对两组手术前后临床疗效进行主、客观比较评价;采用腰椎动力位片及测量腰椎Cobb角进行影像学评价,记录末次随访时相邻节段退变(ASD)发生情况。结果两组患者术前JOA评分、VAS评分及腰椎Cobb角差异均无统计学意义(均P>0.05)。治疗组手术时间较对照组缩短,术中出血量亦较对照组减少,术后卧床时间亦较对照组短[(79±14)比(118±17)min、(151±38)比(324±70)ml和(3.4±0.7)比(4.3±1.0)d,t=-8.508、-10.724、-3.244,均P<0.01]。与对照组相比,治疗组术后引流量也明显减少(t=-5.637,P<0.01)。术后1年两组JOA评分差异无统计学意义(P>0.05),而治疗组VAS评分优于对照组(P<0.05)。与对照组相比,术后1年治疗组腰椎Cobb角明显增加(55.3°±3.2°比38.4°±6.2°,t=10.391,P<0.05)。随访期间所有患者均无内植物松动、断裂发生。结论采用超声骨刀行保留棘上韧带连续性的椎板回植、神经根管扩大术治疗腰椎退变疾病,可取得与全椎板切除减压、PLIF相同的临床疗效,且有手术时间短、出血少、术后腰椎曲度得到良好维持、减少相邻节段退变等优点。Objective To explore the clinical effect of lumbar discectomy and nerve root canal′s enlargement preserving the continuity of supraspinous ligament in the treatment of lumbar degenerative disease.Methods The data of patients with lumbar degenerative disease who underwent operation from 2016 to 2018 were analyzed retrospectively,and the patients were divided into two groups according to the different operation.The treatment group(17 cases)was treated with recapping laminoplasty,lumbar discectomy and nerve root canal′s enlargement,and the control group(28 cases)was treated with total laminectomy,nerve root canal′s enlargement,lumbar discectomy,interbody fusion and internal fixation(PLIF).All patients were followed up for 12 to 27 months(mean 17.8 months).Japanese Orthopaedic Association Scores(JOA)and visual analogue scale(VAS)of pain were used to evaluate the clinical effect before and after the operation,lumbar dynamical X-ray and Cobb angle were collecting for imaging evaluation,and the adjacent segment degeneration at the last follow-up was recorded.Results There was no significant difference in preoperative JOA score,VAS score and Lumbar Cobb angle between the two groups(all P>0.05).The operation time in the treatment group was shorter than that in the control group,and the blood loss during operation in the treatment group was lower than that in the control group,the bed rest time of the treatment group after operation was shorter than that in the control group((79±14)vs(118±17)min,(151±38)vs(324±70)ml and(3.4±0.7)vs(4.3±1.0)d,respectively;t=-8.508,-10.724,-3.244,all P<0.01).In addition,compared with the control group,the volume of postoperative drainage in the treatment group also decreased significantly(t=-5.637,P<0.01).There was no significant difference in JOA score between the two groups 1 year after the operation(P>0.05),but there was significant difference in VAS score between the two groups,the treatment group was better than the control group(P<0.05).Compared with the control group,the lu

关 键 词：腰椎 腰椎管狭窄症 腰椎间盘突出症 腰椎融合术 腰椎间盘切除术 

分 类 号：R687.3[医药卫生—骨科学]