复杂性腰椎管狭窄症手术方法比较

目的 评估椎板切除后外侧融合术，椎板切除椎间融合经椎弓根内固定术治疗复杂性腰椎管狭窄患者的术后近，中期疗效。方法 有21例患者接受椎板切除后外侧融合术，22例患者接受椎板切除椎间融合椎弓根内固定术，术后进行Oswestry疗效评定和腰椎影像学观察。结果 术后1年疗效优良率后外侧融合组为81.0%。椎间融合固定组为81.8%。术后1年两组疗效优良率无显著差别。术后4年疗效优良率后外侧融合组为72.2%,椎间融合组为78.9%。术后4后外侧融合组疗效下降显著，椎间融合组疗效下降不显著，结论 椎板切除椎间融合经椎弓根内固定术，椎板切除后外侧融合术治疗复杂性腰椎管狭窄症，术后近期疗效均满意，椎板切除后外侧融合组术后中期疗效下降，其腰椎不稳定和腰椎管再狭窄发生率较高。

A comparative study of the surgical techniques used for the treatment of complex stenosis of lumbar spine

Objective:To evaluate the surgical techniques and outcomes for complex stenosis of lumbar spine Methods:Laminectomy and posterolateral fusion were performed in 21 patients. Laminectomy and inter-body fusion with instrumentation were performed in 22 patients. The surgical outcomes were evaluated with Oswestry Disability Index and radiological findings from one to four years postoperatively. Results:The satisfactory clinical results was achieved in 81.0% of the patients with posterolateral fusion and in 81.8% of the patients undergone interbody fusion one year after surgery. The rate of satisfactory clinical results dropped to 72. 2% in posterolateral fusion group,however it was maintained in 78.9% of the cases undergone interbody fusion groups four years after surgery. Conclusion:The short-term outcomes of posterolateral fusion,interbody fusion with instrumentation for complex steneosis of lumbar spine were equally satisfactory in both groups. The medium-term surgical outcomes was maintained in patients treated by instrumented fusion,however it was deteriorated in patients with decompression fusion.