退行性腰椎管狭窄症选择性椎板减压术后下床时间对其疗效影响的研究

[摘要] 目的 探讨退行性腰椎管狭窄症选择性椎板减压手术治疗后卧床时间与术后临床疗效的关系。方法 将进行选择性腰椎板减压加神经根管扩大手术患者148例根据术后下床时间分为观察组和对照组,其中术后3d下床者为观察组共78例,术后2周下床者为对照组为70例;随访时间最短18个月,最长66个月,平均（46.21±16.98）个月。统计两组病例的性别、年龄、病程、病变责任节段、术前、术后1个月、术后的JOA（15分法）及疗效。结果 观察组和对照组的组内、组间近、远期JOA评分及临床疗效等结果数据经统计学分析提示差异无显著性（P﹥0.05）。结论 对于退行性腰椎管狭窄症通过对"责任节段"进行选择性椎板减压神经根管扩大手术后患者,由于手术过程及方式最大限度的保留了椎体结构的稳定性。因此,手术后下床活动时间的早晚对临床疗效并无影响;然而,早期离床下地活动对于减少卧床并发症、促进肢体血液循环,增强骨骼的负重能力及肌肉组织的力量,提高患者自信心,缩短康复过程,提高生活质量等又有着积极的意义。

The Effects of the Time of Getting off Bed in Patients with Degenerative Lumbar Spinal Stenosis after Selected Decompressive Laminectomy

Objective: To explore the relationship between the time of getting off bed after Selected Decompressive Laminectomy and clinical therapeutic effect. Method: From May, 2003 to May, 2007, the total of 148 patients with degenerative lumbar spinal stenosis received Decompressive Laminectomy. According to the time of getting off bed after Decompressive Laminectomy, they were divided into experimental group and control group, the experiment group had 78 cases, and the control group had 60 cases. The mean follow-up period was 46.21±16.98 months (minimum 18 months, maximum 66 months). The data of sex, age, course of disease, pathological responsibility segments, pre-operative, postoperative 1 month, Japanese Orthopedic Association (JOA), and therapeutic effect were collected. The statistical program, PEMS 3.1 was used for data analysis. Results: According to the statistical analysis, there was no statistical difference between JOA score and therapeutic effect (p>0.05). Conclusion: Because the process and the way of Decompressive Laminectomy can retain the stability of centrum structure at maximum, it was widely accepted for the treatments of the patients with degenerative lumbar spinal stenosis. And the time of getting off bed after Decompressive Laminectomy had no influence on clinical therapeutic effect. However, to get off bed earlier can prevent many postoperative complications, promote the blood circulation of limbs, enhance the heavy ability of skeleton and muscle, and encourage the confidence of patients, as well as, it has positive effects on shortening recovery time and improving the quality of life.