改良经后路腰椎间融合术治疗腰椎管狭窄症伴腰椎不稳45例分析

目的探讨改良经后路腰椎间融合术治疗腰椎管狭窄症伴腰椎不稳的临床疗效。方法 45例腰椎管狭窄症伴腰椎不稳患者,采用后路椎板开窗减压、下关节突切除、椎间融合器植入、椎弓根钉内固定的改良术式进行治疗。采用日本骨科协会评分（JOA）、视觉模拟疼痛评分（VAS）及影像学检查评价治疗效果。结果 JOA评分,术前与术后3个月、6个月之间差异有统计学意义（P〈0.05）,术后3个月与6个月之间差异无统计学意义（P〉0.05）。VAS评分,术前与术后3个月、6个月之间差异有统计学意义（P〈0.05）,术后3个月与6个月之间差异有统计学意义（P〈0.05）。影像学检查显示椎间融合良好。结论该术式能对椎管充分减压,椎间融合满意,是治疗腰椎管狭窄症伴腰椎不稳的一种有效方法。

Treatment of unstable lumbar spinal stenosis with improved posterior lumbar interbody fusion surgery of 45 cases

Objective To evaluate the clinical outcomes of treating unstable lumbar spinal stenosis with laminectomy,the inferior articular process resection,interbody cage fusion and pedicle screw internal fixation.Methods Forty-five patients with unstable lumbar spinal stenosis who were treated with this improved posterior lumbar interbody fusion surgery were reviewed retrospectively.The results were evaluated with Japanese Orthopedic Association（JOA）score and visual analogue scale（VAS）,and radiographic findings were also reviewed.Results All cases were followed up,JOA score before surgery was significantly different from that of three months and six months after surgery（P〈0.05）.There was not significant difference between the 3-month follow-up and 6-month follow-up（P〉0.05）.The VAS score for low back pain and leg pain 3months after operation and 6months after operation showed significant difference compared with the preoperative score（P〈0.05）.There was significant difference between that of 3months and 6months after operation（P〈0.05）.Interbody fusion was good.Conclusion The method what we took has satisfied clinical outcome,can decompress sufficiently,and get good interbody fusion rate.