"开窗技术"治疗退行性腰椎管狭窄症融合指征

目的 探讨初次"开窗技术"治疗退行性腰椎管狭窄症融合的指征.方法 对1999年12月至2005年12月收治的145例退行性腰椎管狭窄症患者进行回顾性研究.按术前腰椎条件及手术方法分三组:A组39例,术前合并腰椎失稳运动、退变性滑脱或侧弯,行融合术;B组31例,术前合并腰椎失稳运动、退变性滑脱或侧弯,行非融合术;c组75例,术前无腰椎失稳运动、退变性滑脱或侧 弯,行非融合术.对患者住院天数、手术时间、估计出血量复发、再手术及并发症情况等进行统计分析;采用Oswestry 功能障碍指数(ODI)和疼痛视觉模拟评分(VAS)及满意率等进行疗效评估,并进行统计学分析.结果 所有患者随访时间均在3年以上.C组的住院时间少于A组和B组(P<0.05);A组的手术时间和估计出血量均大于B组和c组,差异均有统计学意义(P<0.05);A、C组长 期疗效优于B组(P<0.05),而A、c两组间差异无统计学意义;三组间的复发或残余症状恶化、再手术及并发症等方面差异没有统计学意义.结论 对于术前合并腰椎失稳、滑脱或侧凸的退变性腰椎管狭窄症患者,即使初次行"开窗技术"减压,也应融合;单纯狭窄患者初次手术则无需融合.

Indication of fusion for degenerative lumbar spinal stenosis treated by "windows technique" laminoforaminotomy

Objective To explore the indications of fusion for degenerative lumbar spinal stenosis treated by"windows technique".Methods From December 1999 to December 2005,145 consecutive patients who were treated by primary decompression with"windows technique" laminoforaminotomy for degenerative lumbar spinal stenosis,a retrospective study,were divided into 3 groups (A and B and C) by preoperative lumbar conditions and surgical methods.In group A,39 patients with spinal instability or degenerative lumbar spendylolithesis or scoliosis underwent decompression and fusion;in group B,31 patients with spinal instability or degenerative lumbar spondylolithesis or scoliosis underwent decompression alone;In group C.75 patients without spinal instability or degenerative lumbar spondylolithesis or scoliosis were treated by decompression without fusion.On hospital medical records to review,they were followed up by telephone and out-patient referral.Statistics the duration of hospitalization,operative time,estimated blood loss;Observed recrudescence and reoperation and complication;and using Oswestry Disability Index and Visual Analog Scale and satisfaction rate for efficacy assessment, application SPSS 13.0 software.Results All 145 patients had at least a 3-year follow-up (ranging 37 to 108 months).In the group C.the duration of hospitalization less than in the group A or B(P<0.05);In the group A,the operative time and estimated blood loss greater than in the group B or C(P<0.05);The group B treated by decompression alone in the presence of instability or spondylolithesis or seoliosis showed the worst results by the Oswestry Disability Index or Visual Analog Scale or ate of satisfaction(P<0.05).The same good results can be obtained in the group A and C.There were not difierent about recrudescence or reoperation or complication in the three groups.Conclusions Fusion should be performed on patients with instability or degenerative lumbar spondylolithesis or scoliosis after primary decompression with"windows technique"laminoforaminotomy.The patient with simple lumbar spinal stenosis undergone primary surgery does not require fusion.