经皮置钉联合单侧开窗跨顶减压治疗双侧腰椎管狭窄症的疗效
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摘要
目的探讨经皮置钉联合单侧开窗跨顶减压治疗双侧腰椎管狭窄症的临床疗效。方法选择我院收治的双侧腰椎管狭窄症患者126例,随机分成两组,观察组采用经皮置钉联合单侧椎板开窗跨顶减压治疗,对照组采用开放置钉联合双侧半椎板切除椎管减压治疗。对两组患者一般手术指标、并发症、治疗后腰痛和腿痛VAS评分以及ODI评分等进行比较。结果观察组的手术时间、出血量、住院时间以及住院费用上比对照组少。两组患者术后均无切口感染等并发症。两组患者术后腰痛和腿痛的VAS评分及ODI评分与术前相比差异有统计学意义。两组之间的腰痛和腿痛的VAS评分及ODI评分在术后6、12个月及末次随访相比较差异有统计学意义。但是两组术后3个月的腰痛和腿痛VAS评分及ODI评分相比差异无统计学意义。结论经皮微创置钉联合单侧椎板开窗跨顶减压治疗双侧腰椎管狭窄症具有创伤小、出血少、住院时间短、恢复快等优点,值得临床推广。
Objective Clinical study on the treatment of bilateral lumbar spinal stenosis with percutane-ous fixation combined with unilateral open-ended spinal canal decompression. Methods 126 patients with bilater-al lumbar spinal stenosis admitted to our hospital were randomly divided into two groups. The observation group wastreated by percutaneous nail combined with unilateral laminar fenestration,and the control group was treated byopen reduction combined with bilateral hemi laminectomy and spinal canal decompression.The two groups of pa-tients with general surgical complications after treatment,index,lumbago and leg pain VAS score and ODI scorewere compared. Results The operation time of the observation group,the amount of bleeding,the time of hospital-ization and the cost of hospitalization were less than those of the control group. There were no complications such asincision infection after operation in the two groups.The two groups were statistically significant postoperative painand leg pain VAS score and ODI score compared with preoperative difference. The two groups had statistical signifi-cance between low back and leg pain VAS score and ODI score after 6 and 12 months and last follow-up phase dif-ference.But the two groups after 3 months of lumbago and leg pain VAS score and ODI score had no significant dif-ference. Conclusions Percutaneous minimally invasive nail combined with unilateral laminar fenestration and de-compression for bilateral lumbar spinal stenosis has the advantages of less trauma,less bleeding,shorter hospitaliza-tion time and quicker recovery.It is worthy of clinical promotion.
Objective Clinical study on the treatment of bilateral lumbar spinal stenosis with percutane-ous fixation combined with unilateral open-ended spinal canal decompression. Methods 126 patients with bilater-al lumbar spinal stenosis admitted to our hospital were randomly divided into two groups. The observation group wastreated by percutaneous nail combined with unilateral laminar fenestration,and the control group was treated byopen reduction combined with bilateral hemi laminectomy and spinal canal decompression.The two groups of pa-tients with general surgical complications after treatment,index,lumbago and leg pain VAS score and ODI scorewere compared. Results The operation time of the observation group,the amount of bleeding,the time of hospital-ization and the cost of hospitalization were less than those of the control group. There were no complications such asincision infection after operation in the two groups.The two groups were statistically significant postoperative painand leg pain VAS score and ODI score compared with preoperative difference. The two groups had statistical signifi-cance between low back and leg pain VAS score and ODI score after 6 and 12 months and last follow-up phase dif-ference.But the two groups after 3 months of lumbago and leg pain VAS score and ODI score had no significant dif-ference. Conclusions Percutaneous minimally invasive nail combined with unilateral laminar fenestration and de-compression for bilateral lumbar spinal stenosis has the advantages of less trauma,less bleeding,shorter hospitaliza-tion time and quicker recovery.It is worthy of clinical promotion.
引文
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[11]柳超,王雷,田纪伟.椎弓根螺钉联合伤椎置钉治疗合并骨质疏松症的胸腰段爆裂骨折[J].中华医学杂志,2013,93(25):1993-1996.
[12]张雅宾,毛克亚,李鹏,等.精准减压治疗腰椎管狭窄症的疗效研究[J].中国矫形外科杂志,2016,24(9):780-784.
[13]MOBBS RJ,LI J,SIVABALAN P,et al.Outcomes after decom-pressive laminectomy for lumbar spinal stenosis:comparison be-tween minimally invasive unilateral laminectomy for bila-teraldecompression and open laminectomy:clinical article[J].JNeurosurg Spine,2014,21(2):179-186.
[14]HU W,ZHAO J,GONG C,et al.A comparation of efficacybetween unilateral laminectomy approach bilateral decompres-sion and traditional total laminectomy decompression in thetreatment of lumbar spinal stenosis[J].Zhonghua Yi Xue ZaZhi,2016,96(21):1673-1676.
[2]YAMAN O,OZDEMIR N,DAGLI A T,et al.A comparison ofbilateral decompression via unilateral approach and classic lami-nectomy in patients with lumbar spinal stenosis:A retrospectiveclinical study[J].Turk Neurosurg,2015,25(2):239-245.
[3]黄开,杨金华.单侧入路双侧减压术和全椎板切除减压术治疗腰椎管狭窄症的临床疗效[J].江苏医药,2016,42(14):1576-1578.
[4]张智,陈小容,叶永杰,等.外科治疗对老年退行性腰椎管狭窄症的影响[J].实用医学杂志,2008,24(16):2827-2829.
[5]HASHIZUME H,YOSHIDA M.Spinal stenosis[J].Nihonrinsho,2014,72(10):1768-1772.
[6]MOISI M,FISAHN C,TKACHENKO L,et al.Unilateral lami-notomy with bilateral spinal canal decompression for lumbar Ste-nosis:A technical note[J].Cureus,2016,8(5):e623.
[7]DOHZONO S,TOYODA H,MATSUMURA A,et al.Clinicaland radiological outcomes after microscopic bilateral decom-pres-sion via a unilateral approach for degenerative lumbar disease:Minimum 5-year follow-up[J].Asian Spine J,2017,11(2):285-293.
[8]PHAN K,TENG I,SCHULTZ K,et al.Treatment of lumbar spi-nal stenosis by microscopic unilateral laminectomy for decom-pression:A technical note[J].Orthop Surg,2017,9(2):241-246.
[9]闫立伟,王文波.单侧开窗潜行减压治疗双侧腰椎管狭窄的临床研究[J].哈尔滨医科大学学报,2014,48(6):509-512.
[10]吕锋.后路减压内固定植骨治疗腰椎管狭窄的临床疗效观察[J].中国矫形外科杂志,2012,20(17):1624-1625.
[11]柳超,王雷,田纪伟.椎弓根螺钉联合伤椎置钉治疗合并骨质疏松症的胸腰段爆裂骨折[J].中华医学杂志,2013,93(25):1993-1996.
[12]张雅宾,毛克亚,李鹏,等.精准减压治疗腰椎管狭窄症的疗效研究[J].中国矫形外科杂志,2016,24(9):780-784.
[13]MOBBS RJ,LI J,SIVABALAN P,et al.Outcomes after decom-pressive laminectomy for lumbar spinal stenosis:comparison be-tween minimally invasive unilateral laminectomy for bila-teraldecompression and open laminectomy:clinical article[J].JNeurosurg Spine,2014,21(2):179-186.
[14]HU W,ZHAO J,GONG C,et al.A comparation of efficacybetween unilateral laminectomy approach bilateral decompres-sion and traditional total laminectomy decompression in thetreatment of lumbar spinal stenosis[J].Zhonghua Yi Xue ZaZhi,2016,96(21):1673-1676.