后路减压融合钉棒系统内固定治疗腰椎管狭窄症的临床效果

目的:探讨后路减压融合钉棒系统内固定治疗腰椎管狭窄症的临床价值。 方法:收集2012年2月~2016年2月收治的70例行后路椎弓根钉棒系统内固定+椎管减压+椎间融合器植骨融合术治疗的腰椎管狭窄症患者的临床资料，手术前后均完成影像学检查，记录患者椎间隙高度、患者腰椎功能评分（JOA）、改良Macnab评分、腰背视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）的变化，评价椎间植骨融合情况，统计手术并发症发生率。 结果:（1）术后3、6、12个月，所有患者椎间隙高度、JOA评分均有上升，腰背部VAS评分、ODI指数均降低，差异有统计学意义（P<0.05）；（2）术后12个月，患者椎间融合A+B级比例达100.00%，改良Macnab分级优良率为95.71%。 结论:后路减压融合钉棒系统内固定治疗腰椎管狭窄症疗效肯定，可在实现充分减压的前提下维持椎间盘稳定性，减少椎间隙高度丢失，恢复患者腰椎功能，减少功能障碍指数，且安全性高。

Therapeutic effects of posterior decompression and fusion with internal fixation by nail-stick system in treatment of lumbar spinal stenosis

Abstract: Objective To investigate the clinical value of posterior decompression and fusion with internal fixation by nail-stick system in the treatment of lumbar spinal stenosis. Methods The clinical data of 70 patients who were admitted to the First Affiliated Hospital of Guangxi University of Science and Technology between February 2012 and February 2016 were treated by posterior pedicle screw internal fixation by nail-stick system combined with spinal canal decompression and interbody fusion with bone graft for lumbar spinal stenosis were collected. Imaging examinations were performed before and after surgery. The changes in intervertebral height, the Japanese Orthopaedic Association (JOA) scores of lumbar, the modified Macnab score, the visual analogue scale (VAS) score of low back and the Oswestry dysfunction index (ODI) were recorded. The interbody fusion was evaluated and the incidence of surgical complications was statistically analyzed. Results At 3, 6 and 12 months after surgery, the intervertebral height and JOA scores were increased, while the VAS score of low back and ODI were decreased (P<0.05). At 12 months after surgery, the proportion of grade A+B interbody fusion reached 100.00%, and the superior rate of modified Macnab classification was 95.71%. Conclusion The posterior decompression and fusion with internal fixation by nail-stick system is effective in treatment of lumbar spinal stenosis. With high safety, the proposed treatment can maintain the stability of intervertebral disc in the premise of full decompression, reduce the loss of intervertebral height, restore the lumbar functions, and reduce the disability index.