摘要
目的：比较单纯减压术与减压融合内固定术治疗伴I度退行性滑脱的腰椎管狭窄症的疗效。方法：1993年1月。2007年6月收治的61例伴I度退行性滑脱的腰椎管狭窄症患者，按手术方法分为单纯减压组（A组）和减压加融合内固定组（B组），A组28例，B组33例。两组年龄、性别、病程及术前JOA评分、腰腿痛VAS评分、椎体滑脱程度及椎间隙高度无统计学差异（P〉0．05）。A组单纯行椎板开窗、椎管潜行扩大术，B组行椎板扩大开窗、后外侧或加椎间融合、椎弓根螺钉内固定术。均获2年以上随访，其中A组25例随访4～12年，平均6．8±4．7年；B组31例随访4～11年，平均6．5±4．1年：两组随访时间无统计学差异（P〉0．05）。比较两组术后2年及末次随访时的JOA评分、腰痛及腿痛VAS评分、滑脱节段的椎间隙高度及滑脱程度变化。结果：B组手术时间、术中出血量均明显大于A组（P〈0．05）。A组并发症3例，其中术中硬脊膜撕裂2例，神经根损伤1例；B组并发症6例．其中术中硬脊膜撕裂3例，术后根性疼痛1例。术后切口感染1例，全麻术后认知功能障碍1例。A组再手术3例，其中2例因腰痛加重伴影像学滑脱加重至Ⅱ度分别于术后5年和6年行内固定融合术，再手术后腰痛缓解；1例因腰痛改善不满意于术后3年行内固定融合术，再手术后症状缓解；B组无再手术病例。术后2年A、B组JOA评分优良率分别为89馏％和90．9％，末次随访时分别为76％和87．1％，两组比较均无统计学差异（P〉0．05）。两组腰痛VAS评分术后2年和末次随访时较术前明显降低（P〈0．05），A组末次随访时较术后2年增加（P〈0．05），B组末次随访时与术后2年比较无统计学差异（P〉0．05），术后2年和末次随访时B组腰痛VAS评分明显低于A组（P〈0．05）。两组腿痛VAS评分术后2年及末次随访时较术前明显降低（P〈0．05），组间比较无统计学差异（P〉0．05）。A组术后滑脱节段椎间高度较术前降低，末次随访时低于术后2年（P〈0．05），滑脱程度术后2年时较术前无加重但末次随访时较术后2年时增加（P〈0．05）；B组术后椎间隙高度维持，滑脱部分复位，术后2年及末次随访时无丢失（P〉0．05）。结论：单纯开窗减压与减压融合内固定术治疗伴I度退行性滑脱的腰椎管狭窄症早期疗效相当。前者损伤小、并发症少但中远期效果下降，而后者能更好维持中远期疗效。
Objectives： To compare the clinical results of simple decompression versus decompression and fusion for lumbar stenosis with I degree degenerative spondylolisthesis. Methods： 61 consecutive cases suffering from lumbar stenosis with I degree degenerative spondylolisthesis between January 1993 and June 2007 were classified into simple decompression group（group A） and decompression and fusion group（group B）. There were 28 cases in group A and 33 cases in group B with no statistic difference with respect to age, gender, course of disease, severity of low back or leg pain, slippage extent or disc height between two groups（P〉0.05）. Cases in group A received window laminectomy, while cases in group B received extensive laminoplasty, transpedicular internal fixation and posterolateral fusion or interbody fusion. All cases were followed up for at least 2 years, while 25 cases in group A and 31 cases in group B were followed up for 4 to 12 years（average, 6.8±4.7 years） and 4 to 11 years（average, 6.5±4.1 years） respectively（P〉0.05）. JOA scores, VAS scores for low back pain and leg pain, disc height and slippage at two year＇s and final follow-up were compared. Results： Group B had more operation time and more intraoperative blood loss （P〈0.05）. Complications were noted in 3 eases of group A （including tearing of dura sac in 2 and nerve root impingement in 1） and 6 eases in groups B（including tearing of dura sac in 3, radiculalgia in 1, wound infection in 1, and cognitive disorder in 1）. 3 eases in group A received revision surgery of decompression and fusion, including 2 eases due to aggravated low back pain and II degree spondylolisthesis respectively 5 and 6 years later, and 1 ease due to unalleviated low back pain three years later. No case in group B received revision surgery. Good to excellent rate of JOA score in group A and group B was 89.8% and 90.9% at two year＇s follow-up, and 78% and 87.1% at the final follow-up respectively, which showed no intergroup statistic difference （P〉0.05）. VAS score for low back pain decreased statistically, both at two year＇s and final follow-up in each group（P〈 0.05）. In group A, the score at final follow-up increased statistically compared with two year＇s counterpart（P〈 0.05）, while in group B, the score remained unchanged（P〉0.05）. The score in group B was statistically smaller than that in group A at each follow-up （P〈0.05）. Postoperative VAS scores for leg pain both at two year＇s follow-up and final follow-up were better than preoperative ones in each group （P〈0.05）, with no significant inter-group difference（P〉0.05）. In group A, disc height significantly decreased more at final follow-up, and significant difference existed between two year＇s and final follow-up（P〈0.05）. Slippage remained unchanged at two year＇s follow-up, but final follow-up had lower disc height than two-year＇s follow-up（P〈0.05）. In group B, the disc height remained unchanged（P〉0.05）, slippage progressed significantly（P〈0.05）, while the reduction was maintained at final follow-up （P〉0.05）. Conclusions： Both simple decompression and decompression combined with fusion can alleviate low back pain and leg pain effectively for lumbar stenosis with I degree degenerative spondylolisthesis at postoperative early stage; simple decompression is relatively minimal invasive with lower incidence of complication, but for long time, the clinical outcome declines, while the latter one has better long time results.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
北大核心
2012年第5期412-417,共6页
Chinese Journal of Spine and Spinal Cord
关键词
腰椎管狭窄症
腰椎滑脱
退行性
减压
融合
内固定
Lumbar stenosis
Lumbar spondylolisthesis
Degenerative
Decompression
Fusion
Internal fixation
