两种不同内固定术对腰椎不稳合并椎管狭窄的疗效比较  

Comparison of the Effects of Two Different Internal Fixation Procedures for Lumbar Instability with Spinal Stenosis

作　　者：宋国明 高坤[2] 董孝龙 王宏修 SONG Guoming;GAO Kun;DONG Xiaolong;WANG Hongxiu(Department of Orthopedics,the Fourth People’s Hospital of Shangqiu,Shangqiu 476100,China;Department of Spinal and Spinal Surgery,Henan Provincial People’s Hospital,Zhengzhou 450000,China)

机构地区：[1]商丘市第四人民医院骨科,河南商丘476100 [2]河南省人民医院脊柱脊髓外科,河南郑州450000

出　　处：《河南医学研究》2025年第6期1064-1067,共4页Henan Medical Research

摘　　要：目的与短节段内固定比较,分析腰椎长节段内固定术椎管扩大减压术用于腰椎不稳合并椎管狭窄的效果。方法选取2021年1月至2023年10月商丘市第四人民医院收治的60例腰椎不稳合并椎管狭窄患者,按随机数字表法分为长节段组、短节段组,各30例。长节段组接受腰椎长节段内固定术椎管扩大减压术,短节段组接受短节段内固定术椎管扩大减压术。比较两组围手术期指标、术后并发症、腰腿痛视觉模拟评分(VAS)、腰椎活动度、腰椎前凸角及术后6个月疗效。结果长节段组失血量、术后引流量多于短节段组,手术时间长于短节段组(P<0.05);术后6个月,长节段组腰痛VAS评分低于短节段组(P<0.05);术后6个月,长节段组腰椎前屈度、后伸度、旋转度均低于短节段组(P<0.05);术后6个月,长节段组患者的优良率、并发症发生率分别为86.67%、3.33%,与短节段组的93.33%、0比较,差异无统计学意义(P>0.05)。结论在腰椎不稳合并椎管狭窄内固定术椎管扩大减压术临床治疗中,短节段内固定术创伤小,腰椎活动度好,而长节段内固定术在改善腰痛方面更具优势,可根据患者具体情况选择。Objective To analyze the efficacy of extended decompression of spinal canal with long lumbar segmental fixation in the treatment of lumbar instability complicated with spinal stenosis.Methods A total of 60 patients with lumbar instability and spinal stenosis were selected from the Fourth People’s Hospital of Shangqiu from January 2021 to October 2023.Patients were divided into long segment group and short segment group according to the random number table method,30 cases each.The long segment group underwent long segment internal fixation and spinal canal enlargement decompression,while the short segment group underwent short segment internal fixation and spinal canal enlargement decompression.The perioperative indicators,postoperative complications,visual analog scale(VAS)scores for low back pain,lumbar motion range,lumbar lordosis angle,and the efficacy at 6 months after surgery were compared between the two groups.Results The long segment group had more blood loss and postoperative drainage volume than the short segment group,and the operation time was longer than the short segment group(P<0.05).At 6 months after surgery,the VAS score of low back pain in the long segment group was lower than that in the short segment group(P<0.05).Six months after surgery,the long segment group had lower lumbar flexion,extension,and rotation than the short segment group(P<0.05).At 6 months after surgery,the excellent and good rate and complication rate in the long-segment group were 86.67% and 3.33%,respectively,which were not significantly different from those in the short-segment group’s 93.33% and 0,respectively(P>0.05).Conclusion In the clinical treatment of lumbar instability with spinal stenosis and internal fixation,short-segment internal fixation has minimal trauma and good lumbar mobility,while long-segment internal fixation has more advantages in improving low back pain.It can be selected according to the specific situation of the patient.

关 键 词：腰椎不稳 椎管狭窄 长节段内固定 椎管扩大减压 腰椎活动度 并发症 

分 类 号：R687.3[医药卫生—骨科学]