三种不同椎管减压术式治疗腰椎管狭窄症的疗效比较  

Comparison of three different spinal decompression methods for lumbar spinal stenosis

作　　者：洪春波 李政阳 王守康 刘永涛 辛兵 HONG Chun-bo;LI Zheng-yang;WANG Shou-kang;LIU Yong-tao;XIN Bing(Xuzhou Medical University,Xuzhou,Jiangsu 221000,China;Department of Orthopedics,Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221000,China)

机构地区：[1]徐州医科大学,江苏徐州221000 [2]徐州医科大学附属医院骨科,江苏徐州221000

出　　处：《颈腰痛杂志》2024年第6期1055-1061,共7页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的比较后方韧带复合体(PLC)的三种不同术式治疗腰椎管狭窄症(LSS)的临床疗效。方法回顾性分析2018年1月至2020年12月在徐州医科大学第一附属医院治疗并获得随访的98例LSS的患者。根据术中对PLC处理方式的不同分为A组(全椎板切除减压术)34例,B组(改良卷帘式减压术)32例和C组(双侧开窗减压术)32例。记录三组围手术期指标(手术时间、术中出血量、术后引流量、隐性失血量、住院天数),以疼痛视觉模拟评分(VAS)评估手术前、后腰腿痛程度,以Oswestry功能障碍指数(ODI)和魁北克背痛残疾评分量表(QBPDS)评估手术前后腰椎功能恢复情况。结果三组手术时间和住院天数无明显差异,但A组的术中失血量、术后引流量及隐性失血量明显大于B、C组(P<0.05);术后三组VAS、ODI及QBPDS评分较术前明显下降(P<0.05),术后3个月B、C组ODI和QBPDS评分显著低于A组(P<0.05),术后3个月C组ODI评分显著低于B组(P<0.05),术后6、12个月三组间ODI评分无明显差异(P>0.05),三组手术术后并发症发生率,C组与A、B组比较无明显差异(P>0.05)。结论三种不同椎管减压术式治疗LSS均有较好的疗效,保留PLC的腰椎管减压术较全椎板切除减压术具有疗效好、安全性高、出血少、创伤小及术后恢复快的优点。Objective To compare the clinical outcomes of three different surgical options for lumbar spinal stenosis(LSS)of the posterior ligamentous complex(PLC).Methods A retrospective analysis was performed on 98 patients with LSS who were treated and followed up in our hospital from January 2018 to December 2020.The patients were divided into group A(total laminectomy decompression,34 cases),group B(modified shutter decompression,32 cases)and group C(bilateral fenestration decompression,32 cases)according to different intraoperative treatment methods of PLC.Perioperative indexes(operative time,intraoperative blood loss,postoperative drainage volume,hidden blood loss,length of hospital stay)were recorded in the three groups,and the degree of lumbar and leg pain before and after surgery was assessed by visual analogue scale(VAS).The Oswestry Disability Index(ODI)and the Quebec Disability Scale for Back Pain(QBPDS)were used to assess lumbar functional recovery before and after surgery.Results There were no significant differences in operation time and hospital stay among the three groups,but the intraoperative blood loss,postoperative drainage and hidden blood loss in group A were significantly higher than those in groups B and C(P<0.05).VAS,ODI and QBPDS scores of the three groups after surgery significantly decreased compared with those before surgery(P<0.05),ODI and QBPDS scores of groups B and C were significantly lower than those of group A 3 months after surgery(P<0.05),ODI score of group C was significantly lower than that of group B 3 months after surgery(P<0.05).There was no significant difference in ODI score between the three groups 6 and 12 months after operation(P>0.05),and no significant difference in the incidence of surgery-related complications among the three groups(P>0.05).Conclusion Three different spinal decompression methods have good efficacy in the treatment of LSS.Compared with total laminectomy,lumbar spinal decompression with PLC preservation has the advantages of better efficacy,higher safety,le

关 键 词：腰椎管狭窄症 后方韧带复合体 全椎板切除术 改良卷帘式减压术 双侧开窗减压术 椎管减压 

分 类 号：R681.57[医药卫生—骨科学]