保留棘突、棘上和棘间韧带的全椎板切除术在腰椎管狭窄症手术中的应用

摘要

目的 观察保留棘突、棘上和棘间韧带的全椎板切除术在治疗腰椎管狭窄症手术中的应用效果.方法 选取90例双侧腰椎管狭窄症患者作为研究对象,患者均经过常规治疗后无效,且不存在其他系统的严重疾病以及手术禁忌证,按随机数字表法分为对照组和观察组各45例.观察组患者卧床4d以及进行基础背肌功能锻炼后,采取保留棘突、棘上和棘间韧带的全椎板切除术;对照组患者采用常规的腰椎全椎板切除减压术.结果 两组患者术后的平均住院时间[对照组(11.23±2.56)d,观察组(7.02±2.30)d]和恢复工作的平均时间[对照组(360.36±6.99)d,观察组(55.36±3.33)d]差异有统计学意义(t=8.206,264.250,P＜0.001),观察组术后疗效优良的人数显著多于对照组术后优良的人数,差异有统计学意义(x2=9.315,P=0.025);比较对照组和观察组两组患者术前、术后的SF-36评分,差异有统计学意义(t=13.589,7.408,P＜0.05),比较两组患者各术前、术后SF-36评分,差异无统计学意义(t=1.351,0.500,P=0.180,0.618);比较两组患者腰部慢性疼痛、神经根黏连和复发方面,差异无统计学意义(x2=2.736,0.720,3.554,P=0.098,0.396,0.059),对照组患者发生腰椎不稳的例数(10例)显著多于观察组(2例),差异有统计学意义(x2=6.154,P=0.013).比较两组患者术中出血量[对照组(1200.11±18.61)mL,观察组(800.22±20.32) mL]和手术时间[对照组(3.4±0.21)h,观察组(2.0±0.12)h]差异有统计学意义(t=97.355,38.829,P＜0.001).结论 保留棘突、棘上和棘间韧带的全椎板切除术在治疗腰椎管狭窄症中具有明显优势,腰椎的稳定性较传统的手术方法高,且具有恢复快、损伤小、并发症少、疗效好的优点.%Objective To explore the application of laminectomy retaining the spinous process,supraspinous and interspinous ligament in treating lumbar spinal stenosis.Methods We selected 90 cases of bilateral lumbar stenosis patients as the research objects.These patients took conventional treatment,but it was invalid.They had no serious disease in other systems and no operation contraindication.The patients were randomized into control group and experimental group,each with 45 cases of patients.Experimental group,who had to stay in bed for four days and had basic back muscle exercise,underwent laminectomy retaining the spinous process,supraspinous and interspinous ligament,while control group underwent routine lumbar laminectomy.Results The average hospital stay [(11.23±2.56)d vs (7.02±2.30) d] and recovery time [(360.36±6.99) d vs (55.36±3.33) d] were significantly different between control group and experimental group (t=8.206,264.250,P＜0.001).After the operation,the number of patients with excellent curative effect in experimental group was significantly higher than that of control group (x2 =9.315,P=0.025).Preoperative and postoperative SF-36 scores were significantly different between control group and experimental group(t =13.589,7.408,P ＜ 0.05).There were no significant differences between preoperative SF-36 score and postoperative SF-36 score within control group and experimental group respectively(t =1.351,0.500,P =0.180,0.618).No significant differences were found in chronic lumbar pain,nerve root adhesion and recurrence between the two groups (x2 =2.736,0.720,3.554,P =0.098,0.396,0.059).There were 10 cases of instability of lumbar spine in control group,significantly higher than that in experimental group (2 cases,x2 =6.154,P =0.013).Statistical differences were found in intraoperative bleeding [(1200.11 ±18.61) mL vs (800.22 ± 20.32) mL] and operation time [(3.4 ± 0.21) h vs (2.0± 0.12) h] between the two groups (t =97.355,38.829,P ＜ 0.001).Conclusions Laminectomy retaining the spinous process,supraspinous and interspinous ligament in the treatment of lumbar spinal stenosis has obvious advantages of quick recovery,less injury,fewer complications and good efficacy.And the stability of lumbar spine is better than the traditional operation.and it has the advantages of.