半椎板和全椎板减压治疗腰椎管狭窄症的疗效比较  

Efficacy comparison of hemilaminectomy and total laminectomy for treatment of lumbar spinal stenosis

作　　者：赵晓峰 马真胜 张扬 李天清 ZHAO Xiao-feng;MA Zhen-sheng;ZHANG Yang;LI Tian-qing(Dept of Spine Surgery,the Second Affiliated Hospital of Xi′an Medical University,Xi′an,Shaanxi 710038,China;SectionⅣ,Dept of Orthopaedics,the First Affiliated Hospital of AIR Force Medical University,Xi′an,Shaanxi 710032,China)

机构地区：[1]西安医学院第二附属医院脊柱外科,陕西西安710038 [2]空军军医大学第一附属医院骨四科,陕西西安710032

出　　处：《临床骨科杂志》2021年第5期626-630,共5页Journal of Clinical Orthopaedics

摘　　要：目的比较半椎板和全椎板减压治疗腰椎管狭窄症的临床疗效。方法将55例腰椎管狭窄症患者按照减压方法不同分为半椎板组(采用半椎板减压椎间植骨融合内固定治疗,29例)和全椎板组(采用全椎板减压椎间植骨融合内固定治疗,26例)。比较两组手术情况、临床疗效、骨融合及并发症发生情况。结果患者均获得随访,时间25~48个月。①手术情况:手术时间、术中出血量、住院时间半椎板组均明显短(少)于全椎板组(P<0.01)。②临床疗效:两组VAS评分、ODI、JOA评分术后及末次随访时均明显优于术前(P<0.01),且末次随访时明显优于术后(P<0.01)。末次随访时ODI半椎板组明显低于全椎板组(P<0.05),JOA评分改善率半椎板组明显高于全椎板组(P<0.05)。③骨融合及术后并发症发生情况:两组植骨融合率均达100%,并发症发生率两组比较差异无计学意义(P>0.05)。结论半椎板和全椎板减压均可有效治疗LSS,但半椎板减压具有手术时间短、术中出血量少、患者恢复快、临床疗效好等优点,在严格把握适应证的前提下可优选半椎板减压。Objective To compare the clinical efficacy of hemilaminectomy and total laminectomy in the treatment of lumbar spinal stenosis(LSS).Methods The 55 patients with LSS were divided into hemilaminectomy group(29 cases treated with hemilaminectomy decompression and interbody fusion and internal fixation)and total laminectomy group(26 cases treated with total laminectomy decompression and interbody fusion and internal fixation).The operation situation,clinical efficacy,bone fusion and complications incidence were compared between the two groups.Results All patients were followed up for 25~48 months.①Operation situation:the operation time,intraoperative blood loss and hospital stay in the hemilaminectomy group were significantly shorter(less)than those in the total laminectomy group(P<0.01).②Clinical efficacy:at the postoperation and last follow-up,the VAS,ODI and JOA scores of two groups were significantly better than those before operation(P<0.01),and the data at the last follow-up were significantly better than those after operation(P<0.01).At the last follow-up,the ODI of hemilaminectomy group was significantly lower than the total laminectomy group(P<0.05),the JOA score improvement rate of the hemilaminectomy group was significantly higher than that of the total laminectomy group(P<0.05).③Bone fusion and complications incidence situation:the fusion rate of the two groups reached 100%,and there was no significant difference in the incidence rate of complications between the two groups(P>0.05).Conclusions Both hemilaminectomy and total laminectomy are effective in the treatment of LSS,while hemilaminectomy has the advantages of shorter operation time,less intraoperative blood loss,and faster recovery and better clinical outcome.Under strictly grasp the indications,hemilaminectomy can be selected firstly.

关 键 词：腰椎管狭窄症 半椎板减压 全椎板减压 内固定 

分 类 号：R681.5[医药卫生—骨科学] R687.3[医药卫生—外科学]