半椎板或全椎板减压解除腰椎滑脱致神经根受压症状的疗效比较

目的　探讨对腰椎滑脱合并单侧肢体神经症状患者的最佳手术方式。方法　自 1 995年 1月～ 2 0 0 1年 1 2月 ,共收治腰椎滑脱伴有单侧肢体神经症状的患者 6 7例 ,分别行症状侧半椎板减压 (n =33)和广泛全椎板减压 (n =34)。两组均同时经椎弓根内固定系统复位、固定加植骨融合。比较两组的手术时间、失血量、住院时间、植骨融合率、临床疗效满意率及并发症的发生率。并行样本t检验或x2 检验进行统计学比较。结果　两组在临床满意率、术中失血量和并发症的发生率方面 ,没有统计学显著性差异 ,但是 ,手术时间、住院天数和植骨融合率方面却有显著性差异。行半椎板减压术式组明显优于全椎板减压术式组。结论　对于合并有单侧肢体神经症状的腰椎滑脱患者 ,行症状侧半椎板减压、经椎弓根内固定系统固定及植骨融合术 ,是一种有效的治疗方式 ,并能缩短患者的手术时间和住院天数 ,增加患者的植骨融合率。

The Comparative Study of Treatment of Spondylolisthesis with Unilateral Sciatica by Decompression with Semilaminectomy or Full-Laminectomy

Objective To determine whether semi laminectomy decompression is more advantage than full laminectomy decompression in treating spondylolisthesis with unilateral sciatica. Methods From January 1995 to December 2001,67 cases of spondylolisthesis with unilateral sciatica were randomly assigned to two groups.The first group (n=33) patients were treated with semi laminectomy and decompression of symptomatic side.Interlaminar process fusion of the opposite side and intertransverse process arthrodesis with bone grafting and with transpedicle instrument fixation system.The second group (n=34) patients were treated with full laminectomy decompression intertransverse process arthrodesis with bone grafting and with transpedicle instrument fixation system.Operating time,blood loss,duration of hospital stay,fusion rates,clinical outcomes and complication rates were studied and tested with independent sample t test and x 2 test. Results There were no significant difference between the two groups in clinically satisfactory results,blood loss and complication rates.There were significant difference in duration of operating time,duration of hospital stay and fusion rates. Conclusion Semi laminectomy and decompression of symptomatic side interlaminar process fusion of the opposite side and intertransverse process arthrodesis with bone grafting and with transpedicle instrument fixation system is an effective method to treat the patients of spondylolisthesis with unilateral sciatica.