后路腰椎全椎板减压术后腰椎失稳对预后的影响

【摘要】目的 通过对后路全椎板减压术后患者进行随访，研究术后腰椎失稳与腰椎预后的关系。方法 回顾1990年1月1日至2014年12月31日期间的全椎板减压患者共132例进行随访，其中76例患者获得4年以上随访。通过末次随访的影像学资料将患者分为失稳组以及无失稳组，比较两组术前、术后1个月以及末次随访的VAS评分、JOA评分以及术后JOA改善率等指标，采用t检验及χ2检验方法对所得数据进行统计学分析，以P＜0.05认为差异存在统计学意义。结果 76例手术患者中，共出现腰椎失稳患者27例，未出现腰椎失稳患者49例，分别占病例总数的35.5％和64.5%。经t检验，术前及术后患者VAS评分、JOA评分差异具有统计学意义（P＜0.05）；失稳组与非失稳组上述指标无统计学差异（P＞0.05）；末次随访时，失稳组与非失稳组无统计学差异（P＞0.05）。经χ2检验，非失稳组中改善率稍高于失稳组，但差异无明显统计学意义（P＞0.05）。结论 全椎板减压术作为一种非融合方式，其术后症状改善与否与是否存在失稳无明显关系。在严格掌握手术适应证的前提下，不失为一种更好的选择。

Long term follow up of the spinal stenosis and symptoms after lamina decompression

Abstract: Objective: To study the relationship between the spinal instability and symptoms after lamina decompression. Method: Of 132 patients who accepted lamina decompression from 1990 through 2014, 76 were followed up for a minimum of 4 years. The patients were divided into instability group and non-instability group according to the X-ray result of the last following up. Compare with the VAS score, JOA score between the two group of the preoperation, 1 month after operation and the last follow up, and the JOA improvement rate index before and after the surgery, t test and chi square test method was used to analyze the outcome, with P < 0.05 a statistically significant difference. Results: Of the 76 patients, there were 27 patients in the instability group and 49 patients in the non-instability group which accounting for 35.5% and 64.5%. There were statistical significant in the VAS and JOA score between before and after surgery (P<0.05), but there were no statistical significant in the two groups(P >0.05). In the JOA improvement rate index, the non-instability group is higher than the instability group ,but no statistical significant(P>0.05). Conclusion: As a non-fusion method, there is no relationship between instability and symptoms improvement, which would be a better choice under the premise of surgical indications.