椎板切除术或椎管成形术治疗腰椎管狭窄症的疗效比较  

Comparative study of the lumbar spinal stenosis treated by laminectomy or vertebral canaloplasty

作　　者：梅荣成[1] 杨述华[2] 陈智良[1] 丁援建[1] 许建湘[1] 

机构地区：[1]湖北省襄樊市中医院,湖北襄樊441021 [2]华中科技大学同济医学院附属协和医院

出　　处：《实用骨科杂志》2003年第5期393-395,共3页Journal of Practical Orthopaedics

摘　　要：目的 :比较治疗腰椎管狭窄症的手术方法 ,并介绍椎板棘突复合体翻转 90°回植椎管成形术的临床应用。方法 :对我院 1995年 6月～ 1998年 6月资料完整并获得随访的 6 8例腰椎管狭窄症患者进行回顾性分析 ,其中 35例患者行椎板切除术 ,33例患者行椎板棘突复合体回植椎管成形术 ,分别于术后 1年及 5年进行JOA疗效评分和影像学观察。结果 :术后 1年疗效优良率椎板切除组为 91.4%,椎管成形组为 94%,两组疗效优良率无显著性差异。术后 5年疗效优良率 ,椎板切除组为 6 8.6 %,椎管成形组为 90 .9%。术后 5年椎板切除组疗效下降显著 ,椎管成形组疗效下降不显著。且两组疗效优良率有显著性差异。术后 1年所有患者X线检查未显示有腰椎不稳 ,术后 5年X线显示7名患者有腰椎不稳或Ⅰ度腰椎滑脱 ,均在椎板切除组。结论 :椎板切除术和椎管成形术治疗椎管狭窄症 ,近期疗效均满意 ,远期疗效椎管成形组明显优于椎板切除组 ,且腰椎不稳或腰椎滑脱的发生率明显较椎板切除组低。Objective:To compare surgical techniques for the treatment of lumbar stenosis and to describe a new procedured of vertebral canaloplasty through removing the complex of laminae and spinous and reattaching the laminae after being reversed 90°.Methods:From June 1995 to June 1998,68 cases of lumbar spinal stenosis with integrated data which had been followed-up had been analyzed retrospectively.Of them 35 cases were treated with laminectomy and 33 cases were treated with vertebral canaloplasty.The surgical outcome were evaluated with the patient′s JOA low back pain score and radiological findings from one to five years.Results:1 year after operation,the satisfactory clinical results was achieved in 91.4 % patients of undergone laminectomy group and 94 % of vertebral canaloplasty group.5 years after operation,the satisfactory clinical results was achieved in 68.6 % patients of undergone laminectomy group and 90.0 % of vertebral canaloplasty group.There was no significant between the two groups after 1 year operation but it was significant between the two groups after 5 years operation.7 cases with lumbar instability or spondylolisthesis caused by operation 5 years later were all in laminectomy group.Conclusion:The short-term outcomes of laminectomy and vertebral canaloplasty for lumbar spinal stenosis were equally satisfactory.The outcomes in vertebral canaloplasty group were better than that in laminectomy group in the long-term followed-up.The rate of lumbar instability or spondylolisthesis occurred was lower in vertebral canaloplasty group.

关 键 词：腰椎管狭窄症 手术治疗 椎板切除术 椎管成形术 

分 类 号：R681.5[医药卫生—骨科学] R687.3[医药卫生—外科学]