腰椎侧方减压融合内固定术治疗退行性腰椎管狭窄症的早期临床疗效  

Early clinical efficacy of lumbar lateral decompression fusion internal fixation surgery for the treatment of degenerative lumbar spinal stenosis

作　　者：杨承旺 史明 罗满[1] 李小峰 仇振茂 李松 杨艺楠 YANG Chengwang;SHI Ming;LUO Man;LI Xiaofeng;QIU Zhenmao;LI Song;YANG Yinan(The Second Department of Orthopedics,International Zhuang Medicine Hospital Affiliated to Guangxi University of Traditional Chinese Medicine,Nanning 530201;Department of Spinal Orthopedics,Guangxi Orthopedic Hospital,Nanning 530000;Department of Spinal Orthopedics,Guangxi Xing′an Jieshou Orthopedic Hospital,Guilin 541300)

机构地区：[1]广西中医药大学附属国际壮医医院骨二科,南宁530201 [2]广西骨伤医院脊柱骨科,南宁530000 [3]广西兴安界首骨伤医院脊柱骨科,桂林541300

出　　处：《颈腰痛杂志》2025年第2期334-338,共5页The Journal of Cervicodynia and Lumbodynia

基　　金：广西重点研发项目(2024AB04006);广西医疗卫生适宜技术开发与推广项目(S2022060);广西国际壮医医院青苗工程项目(2022001)。

摘　　要：目的观察腰椎侧方减压融合内固定术微创治疗退行性腰椎管狭窄症的早期临床疗效。方法回顾性分析三所医院2020年4月至2023年4月共47例退行性腰椎管狭窄症患者的临床资料,按不同的手术方式分为:腰椎侧方减压融合内固定术组(观察组)和传统后路减压融合内固定术组(对照组),统计并比较两组患者术前及术后1周、4周、3个月、6个月的腰痛视觉模拟评分法(VAS)评分和日本骨科协会(JOA)腰背痛手术评分,分析两组手术时间,术中出血量、术后引流量、平均住院时间的差异,评价治疗效果。结果观察组平均手术时间(108±20)min,术中出血量(75±13)mL,术后引流量(25±8)mL,术后平均住院时间(7.5±2.5)d;对照组平均手术时间(167±13)min,术中出血量(320±45)mL,术后引流量(240±30)mL,术后平均住院时间(10.5±3.5)d;两组在手术时间、术中出血量、术后引流量、住院时长方面比较,差异均有统计学意义(P<0.05)。术后疼痛缓解方面术后1周、4周、3个月及6个月时,观察组的腰痛VAS评分均低于对照组(P<0.05)。在腰椎功能的改善方面,术后4周、3个月、6个月时,观察组的JOA评分均高于对照组(P<0.05)。结论相比传统后路减压融合内固定术,腰椎侧方减压融合内固定术创伤更小,术中及术后出血量更少,住院时间更短,更早减轻疼痛,改善腰椎功能,提高了临床疗效。Objective To evaluate the early clinical efficacy of minimally invasive lateral lumbar decompression,fusion,and internal fixation in the treatment of degenerative lumbar spinal stenosis.Methods A retrospective analysis was conducted on the clinical data of 47 patients with degenerative lumbar spinal stenosis treated in three hospitals between April 2020 and April 2023.The patients were divided into two groups based on the surgical approach:the lateral lumbar decompression,fusion,and internal fixation group(observation group)and the traditional posterior decompression,fusion,and internal fixation group(control group).Preoperative and postoperative(1 week,4 weeks,3 months,and 6 months)low back pain(visual analog scale,VAS)scores and lumbar function(Japanese Orthopaedic Association,JOA)scores were recorded and compared.Additionally,operative time,intraoperative blood loss,postoperative drainage volume,and average hospital stay were analyzed to assess treatment outcomes.Results The observation group had a mean operative time of(108±20)minutes,intraoperative blood loss of(75±13)mL,postoperative drainage volume of(25±8)mL,and an average hospital stay of(7.5±2.5)days.In contrast,the control group had a mean operative time of(167±13)minutes,intraoperative blood loss of(320±45)mL,postoperative drainage volume of(240±30)mL,and an average hospital stay of(10.5±3.5)days.Statistically significant differences were observed between the two groups in operative time,intraoperative blood loss,postoperative drainage volume,and hospital stay(P<0.05).Regarding pain relief,the observation group exhibited significantly lower VAS scores for low back pain at 1 week,4 weeks,3 months,and 6 months postoperatively compared to the control group(P<0.05).In terms of lumbar function improvement,the observation group demonstrated significantly higher JOA scores at 4 weeks,3 months,and 6 months postoperatively compared to the control group(P<0.05).Conclusion Compared to traditional posterior decompression,fusion,and internal fixation,later

关 键 词：腰椎侧方融合术 侧路内固定 退行性腰椎管狭窄症 减压 疗效 椎间盘 

分 类 号：R687.3[医药卫生—骨科学]