椎板开窗潜行减压治疗短节段腰椎侧凸合并椎管狭窄症的疗效分析  

Efficacy of decompressive laminectomy and fenestration for short-segment degenerative lumbar scoliosis combined with spinal stenosis

作　　者：邢顺民 方良勤 徐寅强 谭俊铭[1] XING Shunmin;FANG Liangqin;XU Yinqiang;TAN Junming(Department of Orthopedics VI,the 72nd Group Military Hospital of the People's Liberation Army,Huzhou,Zhejiang 313000,China)

机构地区：[1]中国人民解放军陆军第72集团军医院骨科六病区,浙江湖州313000

出　　处：《中国骨与关节损伤杂志》2024年第5期463-467,共5页Chinese Journal of Bone and Joint Injury

基　　金：湖州市公益性应用研究项目(2022GY34)。

摘　　要：目的比较椎板开窗潜行减压术与后路腰椎椎间融合术治疗短节段腰椎侧凸合并椎管狭窄症的临床疗效。方法回顾性分析自2017-04—2022-10诊治的95例短节段腰椎侧凸合并椎管狭窄症,观察组46例行单纯椎板开窗潜行减压术,对照组49例行后路腰椎椎间融合术。比较两组手术时间、术中出血量、卧床时间、住院时间、并发症发生情况以及Cobb角、JOA评分、疼痛VAS评分、ODI指数。结果所有患者均获得随访,随访时间11~32个月,平均21.3个月。观察组手术时间、术中出血量、卧床时间、住院时间均少于对照组,差异有统计学意义(P<0.05)。观察组与对照组术后1 d、术后2个月、末次随访JOA评分比较,差异均无统计学意义(P>0.05)。观察组与对照组术后2个月、末次随访疼痛VAS评分比较,差异均无统计学意义(P>0.05);而观察组术后1 d疼痛VAS评分低于对照组,差异有统计学意义(P<0.05)。观察组与对照组术后2个月、末次随访ODI指数比较,差异均无统计学意义(P>0.05)。两组术后1 d、术后2个月Cobb角均较术前改善,差异有统计学意义(P<0.05);但是观察组末次随访Cobb角较术前增大,差异有统计学意义(P<0.05)。两组并发症发生率比较差异无统计学意义(P>0.05)。结论椎板开窗潜行减压术治疗短节段腰椎侧凸合并椎管狭窄症手术时间短,出血量少,临床疗效显著,术后并发症发生率低,但是侧凸角度改善略逊于减压融合术,建议术前综合评估老年患者病情后酌情采用。Objective To compare the clinical efficacy of decompressive laminectomy and fenestration and posterior lumbar interbody fusion(PLIF)in the treatment of short-segment lumbar scoliosis with concurrent spinal stenosis.Methods A retrospective analysis was conducted on 95 cases of short-segment lumbar scoliosis with concurrent spinal stenosis treated between April 2017 and October 2022.Forty-six cases underwent decompressive laminectomy and fenestration(observation group),while 49 cases underwent PLIF(control group).Surgical duration,intraoperative blood loss,bed rest time,length of hospital stay,occurrence of complications,as well as Cobb angle,JOA score,pain VAS score,and ODI index were compared between the two groups.Results All patients were followed up for 11 to 32 months,with a mean 21.3 months.The observation group had significantly shorter surgical duration,less intraoperative blood loss,shorter bed rest time,and shorter hospital stay compared to the control group(P<0.05).There were no significant differences in JOA scores at 1 day postoperatively,2 months postoperatively,and final follow-up between the two groups(P>0.05).There were no significant differences in pain VAS scores at 2months postoperatively and final follow-up between the two groups(P>0.05);however,the observation group had significantly lower pain VAS scores at 1 day postoperatively compared to the control group(P<0.05).There were no significant differences in ODI index at 2 months postoperatively and final follow-up between the two groups(P>0.05).Cobb angles at 1 day postoperatively and 2 months postoperatively were significantly improved compared to preoperative values in both groups(P<0.05);however,the observation group showed a significant increase in Cobb angle at final follow-up compared to preoperative values(P<0.05).There were no significant differences in the incidence of complications between the two groups(P>0.05).Conclusion decompressive laminectomy and fenestration for the treatment of short-segment lumbar scoliosis with concurrent

关 键 词：腰椎侧凸 腰椎管狭窄 椎板开窗潜行减压 脊柱融合固定术 

分 类 号：R687.3[医药卫生—骨科学]