棘突劈开入路与传统入路治疗多节段腰椎管狭窄症的效果比较  

Comparison of the effect of spinous process splitting approach and traditional approach in the treatment of multi-segment lumbar spinal stenosis

作　　者：林克凤 严锦 LIN Kefeng;YAN Jin(Department of Orthopedics,Fuzhou University Affiliated Provincial Hospital,Fujian Province,Fuzhou350000,China)

机构地区：[1]福州大学附属省立医院骨科,福建福州350000

出　　处：《中国当代医药》2024年第36期83-87,共5页China Modern Medicine

基　　金：福建省自然科学基金资助项目(2023J011172)。

摘　　要：目的比较棘突劈开入路与传统入路治疗多节段腰椎管狭窄症的效果。方法回顾性分析2019年6月至2023年6月福州大学附属省立医院收治的65例多节段腰椎管狭窄症的患者,根据手术入路方式不同分为棘突劈开组(32例)和传统入路组(33例)。棘突劈开组采用后路棘突劈开入路,传统入路组采用后路双侧椎旁肌剥离入路,两组均进行常规椎板切除椎管减压术治疗。统计比较两组间手术时间、出血量、住院时间及并发症。术后6个月通过Oswestry功能障碍指数(ODI)评估比较两组间腰椎功能,背痛和腿痛情况则采用视觉模拟量表(VAS)评分进行评估比较。结果棘突劈开组的手术时间和住院时间均短于传统入路组,差异有统计学意义(P<0.05)。两组术中出血量及术后引流量比较,差异无统计学意义(P>0.05)。两组术后并发症总发生率比较,差异无统计学意义(P>0.05)。术后3 d及6个月,棘突劈开组患者的VAS评分低于传统入路组,差异有统计学意义(P<0.05)。术后6个月,两组的ODI均低于本组术前,差异有统计学意义(P<0.05),两组的ODI比较,差异无统计学意义(P>0.05)。术后随访过程,两组均未出现伤口感染、腰椎不稳、神经损伤和椎管内血肿等并发症,棘突劈开组出现1例因缝合不当导致棘突未完全愈合,传统入路组出现2例多裂肌严重萎缩。结论临床中采用棘突劈开入路和传统入路行多节段腰椎管狭窄症手术均可改善腰椎功能和疼痛程度,但棘突劈开入路相较于传统入路可以缩短手术和住院时间,并能减轻术后早期的腰痛症状,利于患者快速康复。Objective To compare the effect of laminectomy for multi-segment lumbar spinal stenosis patients using the spinous process splitting approach versus the traditional approach.Methods A retrospective analysis was conducted on 65 patients with multi-segment lumbar stenosis who were treated at Fuzhou University Affiliated Provincial Hospital from June 2019 to June 2023.The patients were divided into the spinous process splitting approach group(n=32)and the traditional approach group(n=33)based on the surgical approach.The spinous process splitting approach group used spinous process splitting approach,the traditional approach group was treated with bilateral paravertebral muscle dissection approach.Both groups underwent conventional laminectomy and decompression of the spinal canal.The surgical time,blood loss,hospital stay,and complications were statistically compared between the two groups.The Oswestry disability index(ODI)was used to evaluate the lumbar function at 6 months after surgery,while the visual analogue scale(VAS)was used to assess back and leg pain.Results The surgical time and hospital stay of the spinous process splitting approach group were shorter than those of the traditional approach group,with statistically significant differences(P<0.05).There were no significant differences in the amount of intraoperative bleeding and postoperative drainage between the two groups(P>0.05).There was no significant difference in the total incidence of postoperative complications between the two groups(P>0.05).The VAS scores of the spinous process splitting approach group were lower than those of the traditional approach group at 3 days and 6 months after surgery,with statistical significances(P<0.05).6 months after surgery,the ODI scores of the two groups were lower than those before surgery,with statistical significances(P<0.05),but there was no significant difference between the two groups(P>0.05).During the follow-up period,no complications such as wound infection,instability of the lumbar spine,nerve injury,an

关 键 词：棘突劈开 腰椎后路 腰椎管狭窄症 椎管减压术 

分 类 号：R687[医药卫生—骨科学]