椎板切除术和多节段开窗术治疗69例腰椎管狭窄疗效比较

[背景]比较观察椎板切除术和多节段开窗术对腰椎管狭窄的治疗结果.[病例报告]对资料完整的69例腰椎管狭窄患者进行回顾性分析,其中接受椎板切除术者为35例,接受多节段开窗术者为34例,分别于术后1,5年进行JOA疗效评分及影像学观察.椎板切除术组术后1年临床疗效优良率为86%,多节段开窗术组为88%;椎板切除术组术后5年临床疗效优良率为69%,多节段开窗术组为82%,两组比较有显著性差异.术后1年X线检查均未见腰椎不稳,术后5年椎板切除术组6例出现腰椎不稳或I0腰椎滑脱.[讨论]椎板切除术和多节段开窗术治疗椎管狭窄的近期疗效均满意,而多节段开窗术远期疗效明显优于椎板切除术,且腰椎不稳及腰椎滑脱发生率较低.

Therapeutic comparation of laminectomy and multiple segmental fenestration on 69 cases of lumbar spinal stenosis

BACKGROUND To compare the therapeutic effects between laminectomy and multiple segmental fenestration on lumbar spinal stenosis.CASE REPORTS 69 cases of lumbar spinal stenosis with integrated data which had been followed-up were analyzed retrospectively.Of them,35 cases were treated with laminectomy and 34 cases with multiple segmental fenestration.The surgical outcomes were evaluated with the patient's JOA low back pain score and radiological findings in 1 and 5 years.1 year after operation,the satisfactory clinical results were achieved in 86% patients of undergone laminectomy group and 88% of multiple segmental fenestration group.5 years after operation,the satisfactory clinical results were achieved in 69% patients of undergone laminectomy group and 82% of multiple segmental fenestration group.There was significant different between the two groups after 5 years operation.6 cases with lumbar instability or spondylolisthesis caused by operation 5 years later were all in laminectomy group.DISCUSSION The short-term outcomes of laminectomy and multiple segmental fenestration for lumbar spinal stenosis were equally satisfactory.The outcomes in multiple segmental fenestration 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 multiple segmental fenestration group.