保留后方韧带复合体有限减压植骨融合治疗腰椎管狭窄症 20例效果分析

目的 比较采用椎弓根螺钉固定有限减压保留韧带复合体与改良全椎板减压术治疗退行性腰椎管狭窄症的效果.方法 回顾性分析2016年6月至2019年10月间在安徽医科大学附属海螺医院、十七冶医院、解放军第八六医院经手术治疗并获得随访的40例退行性腰椎管狭窄症病人.分为研究组和对照组,各20例,研究组采用选择性椎板扩大开窗减压,对照组采用改良全椎板减压,两组进行减压同时均行椎弓根钉棒固定椎间植骨融合术.比较两组手术时间、术中出血量、术后引流量、术后下地时间、住院时间及两组术前、术后各时段的Oswestry功能障碍指数(ODI)和疼痛视觉模拟评分(VAS).结果 研究组手术时间短[(97.10±18.78)min比(150.75±19.81)min]、术中出血量少[(121.90±32.94)mL比(302.85±64.88)mL]及术后引流量少[(182.03±33.84)mL比(296.90±68.63)mL]、术后下地时间短[(3.90±0.79)d比(7.15±0.67)d]、住院时间短[10 d比13 d](P<0.05);两组治疗后腰痛VAS、腿痛VAS评分均较之前有改善,且研究组改善幅度更显著(P<0.05).结论 两种手术方式在治疗退变性腰椎管狭窄症均有较好的疗效,保留后方韧带复合体有限减压椎间植骨融合内固定手术方式治疗退行性腰椎管狭窄症,具有手术时间短、出血少,减压效果显著,手术安全有效.

Analysis of the effect of limited decompression of the posterior ligament complex and bone graft fusion on 20 cases of lumbar spinal stenosis of lumbar spinal stenosis

Objective To compare the effects of pedicle screw fixation with limited decompression-retaining ligament complex and modified total laminar decompression in the treatment of degenerative lumbar spinal stenosis.Methods Retrospective analysis was performed on 40 patients with degenerative lumbar spinal stenosis who received surgical treatment and follow-up visits in Conch Hospital Affiliated to Anhui Medical University, 17th MCC Hospital, and 86th Hospital of the People''s Liberation Army from June 2016 to October2019. Patients were assigned into study group and control group, each with 20 cases. The study group used selective laminectomy to expand the window for decompression, and the control group used a modified total laminar decompression. Decompression was performed inboth groups and intervertebral graft fusion was performed with pedicle screw and rod fixation. The operation time, intraoperative bloodloss, postoperative drainage volume, postoperative landing time, hospitalization time, Oswestry disability index (ODI) and pain visual analog scale (VAS) before and after of the two groups were compared.Results In the study group, the operative time was shorter [(97.10± 18.78) min vs. (150.75±19.81) min], the intraoperative blood loss was less [(121.90±32.94) ml vs. (302.85±64.88) ml] and the postoperative drainage volume was less [(182.03±33.84 )ml vs. (296.90±68.63)] ml]]ml], the postoperative time to go to ground was shorter[(3.90± 0.79) d vs. (7.15±0.67) d], the hospitalization time was shorter (10 d vs. 13 d) (P<0.05). After treatment, the back pain VAS and leg painVAS scores were improved compared with the previous ones, and the improvement in the study group was more significant (P<0.05).Con? clusion Both surgical methods have a good effect in the treatment of degenerative lumbar spinal stenosis. The limited decompression ofthe posterior ligament complex and the intervertebral bone fusion and internal fixation surgery are used to treat degenerative lumbar spinal stenosis, with the advantages of short operation time, less bleeding, significant decompression, and safe and effective surgery.