单纯椎管扩大减压术与减压联合椎管成形术的临床疗效比较

目的：比较单纯椎管扩大减压、减压+羟基磷灰石/聚酰胺人工椎板重建以及减压+钛网椎板重建3种手术方式在治疗腰椎管狭窄症中的临床疗效。方法：回顾性分析腰椎管狭窄行手术治疗的39例患者，其中单纯椎板减压术组15例(A组)、减压+羟基磷灰石/聚酰胺人工椎板重建组14例(B组)、减压+钛网椎板重建组10例(C组)，比较3组在手术情况、术后优良率及JOA评分等方面是否有差异。结果：A组手术时间、术中出血量明显小于B，C组(P<0.05)，B与C组差异无统计学意义(P>0.05)。术后疗效评价：术后3个月3组比较差异无统计学意义(P>0.05)；术后12个月，B与C组优良率明显高于A组(P<0.05)。JOA评分：术后3个月、12个月均高于术前(P<0.05)；术后3个月3组间比较差异无统计学意义(P>0.05)；术后12个月B，C两组高于A组(P<0.05)。3组均无重大并发症。术后影像学改变无明显差异。结论：单纯椎管扩大减压、减压+羟基磷灰石/聚酰胺人工椎板重建以及减压+钛网椎板重建3种术式均为治疗腰椎管狭窄症安全有效的手术方法，但后两者临床疗效优于前者。

Comparison of the clinical efficacy between simple vertebral canal decompression and decompression plus laminoplasty

Objective: To observe the clinical efficacy of the simple expansion of the spinal canaldecompression, decompression plus hydroxyapatite/polyamide artificial lamina reconstruction,and decompression plus titanium mesh reconstruction in the treatment of spinal canal stenosi.Methods: A total of 39 patients with lumbar spinal stenosis (with or without disc herniation,spondylolisthesis less than I degree), who received therapy of surgery from January, 2011 to January,2012, were retrospectively analyzed. All patients were divided into 3 groups: a laminectomy surgeryalone group (group A, n=15), a decompression plus hydroxyapatite/polyamide artificial laminareconstruction group (group B, n=14), and a laminectomy decompression plus reconstruction withtitanium mesh group (group C, n=10). Intraoperative situation, the postoperative excellent rate andJOA score were analyzed.Results: The duration and blood loss in surgery in group A was much less than that in the groupB and C (P<0.05), but there was no statistical significance between the group B and C. Thepostoperative excellent rate in three groups were similar in 3 months (P>0.05). Twelve monthsafter the surgery, the group B and C showed advantage over the group A (P<0.05). JOA scores in 3and 12 months after the surgery were all greater than that before the surgery (P<0.05). There wasno difference in excellent rates in 3 groups in 3 months after the operation (P>0.05); the group Band C showed advantage over the group A in 12 months after the operation (P<0.05). No seriouscomplications were related to the surgery in the 3 groups. Imaging changes were not significantdifference.Conclusion: The decompression plus hydroxyapatite/polyamide artificial lamina reconstructionand the decompression plus titanium mesh reconstruction show advantages in long-term effect overthe simple vertebral canal decompression.