有限保留椎板的椎管扩大减压术治疗腰椎管狭窄症的疗效分析

摘要

Objective To explore the feasibility of vertebral enlarging decompression with limited reserved vertebral lamina,reserved stable lumbar posterior structure in the treatment of lumbar spinal stenosis.Methods 48 cases of lumbar spinal stenosis from March 2013 to February 2015 were treated by vertebral enlarging decompression and inter-vertebral fusion with pedicle screw-rod fixation with limited reserved vertebral lamina and posterior ligamentous complex.Recorded preoperative,postoperative,at the sixth month of followup VAS score and ODI of back and leg,evaluated the clinical effect.Results Pain relief of back and leg occurred in early postoperative period.There were 43 cases of VAS score below 3,5 cases of VAS score 4-5.At the sixth month of follow-up,the activity of daily living of patients significantly improved,ODI value dropped from preoperative (54.15±21.61)％ to (8.t0±6.74)％,the excellent and good rate was 95.8％.Conclusions Vertebral enlarging decompression with limited reserved vertebral lamina in the treatment of lumbar spinal stenosis has complete decompression,better early phase efficacy,without increased operation difficulty,contribute to early functional rehabilitation,worthy of clinical promotion.%目的 探讨有限保留椎板,保留腰椎后方稳定结构的椎管扩大减压术治疗腰椎管狭窄症的可行性.方法 对2013年3月至2015年2月期间48例腰椎管狭窄症患者,采用有限保留椎板及后方韧带复合体的腰椎管扩大减压、椎间融合椎弓根钉棒内固定术进行治疗,记录住院期间术前、术后,以及半年随访时的腰背、下肢疼痛VAS评分,Oswestry功能障碍指数(ODI),进行统计分析,评估其临床效果.结果 术后早期对腰背、下肢疼痛缓解获得了良好的效果.术后43例患者VAS评分在3分以下,5例VAS评分4～5分;术后半年随访,患者日常生活能力获得明显的改善,ODI值从术前的(54.15±21.61)％下降至(8.10±6.74)％,疗效评定优良率达95.8％.结论 有限保留椎板的椎管扩大减压术治疗腰椎管狭窄,减压彻底,不增加手术操作难度,早期疗效确切,有助于早期功能康复,临床上值得推广.