有限开窗手术治疗腰椎间盘突出症并发椎管狭窄疗效观察

摘要

目的 探讨有限开窗手术治疗腰椎间盘突出症(LIDP)并发椎管狭窄的临床效果.方法 选择中国人民解放军第159医院2014年5月至2016年5月收治的LIDP并发椎管狭窄患者80例,根据治疗方法分为观察组和对照组,每组40例.观察组患者给予椎板间潜行有限开窗、侧隐窝及神经根管减压治疗,对照组患者给予全椎板切除、侧隐窝及神经根管减压治疗.分别于手术前后应用视觉模拟评分法(VAS)对2组患者腰部疼痛进行评分,应用日本骨科学会(JOA)评分法对2组患者腰椎功能进行评分,并观察2组患者术后并发症.结果 术前2组患者腰部疼痛VAS评分比较差异无统计学意义(t=1.638,P＜0.05),2组患者术后腰部疼痛VAS评分均显著低于术前(t=3.182、4.303,P＜0.05),术后观察组患者腰部疼痛VAS评分显著低于对照组(=2.776,P＜0.05).术前2组患者腰椎功能JOA评分比较差异无统计学意义(t=5.170,P＜0.05),2组患者术后腰椎功能JOA评分均显著高于术前(t=28.841、45.070,P＜0.05),术后观察组患者腰椎功能JOA评分显著高于对照组(t=52.952,P＜0.05).对照组和观察组患者治疗总有效率分别为62.5％ (25/40)、92.5％(37/40),观察组患者治疗总有效率显著高于对照组(x2=12.381,P＜0.05).对照组和观察组患者术后并发症发生率分别为25.0％ (10/40)、10.0％ (4/40),观察组患者术后并发症发生率显著低于对照组(x2=11.140,P＜0.05).结论 有限开窗手术能够有效减轻LIDP并发椎管狭窄患者的腰部疼痛,改善腰椎功能,且术后并发症少.%Objective To investigate the effect of intervertebral finite fenestration on lubar intervertebral disc protrusion (LIDP) complicated with spinal stenosis.Methods Eighty patients with LIDP complicated with spinal stenosis were selected from May 2014 to May 2016 in the 159th Hospital of the Chinese People's Liberation Army.The patients were divided into observation group and control group according to the treatment method,40 cases in each group.The patients in the observation group were treated with intervertebral finite fenestration,lateral recess and nerve root canal decompression.The patients in the control group were treated with total laminectomy,lateral recess and nerve root canal decompression.The lumbar pain of patients was evaluated by the visual analogue scale (VAS),and the lumbar function was evaluated by using Japanese Orthopaedic Association(JOA) scoring system in the two groups before and after operation.The postoperative complications were observed in the two groups.Results There was no significant difference in VAS score of lumbar pain between the two groups before operation (t =1.638,P ＜ 0.05).The VAS score of lumbar pain after operation was significantly lower than that before operation in the two groups(t =3.182,4.303,P ＜ 0.05).The VAS score of lumbar pain in the observation group was significantly lower than that in the control group after operation(t =2.776,P ＜ 0.05).There was no significant difference in JOA score of lumbar function between the two groups before operation(t =5.170,P ＜ 0.05).The JOA score after operation was significantly higher than that before operation in the two groups (t =28.841,45.070;P ＜ 0.05).The JOA score of the lumbar function in the observation group was significantly higher than that in the control group after operation(t =52.952,P ＜ 0.05).The total effective rate in the control group and the observation group was 62.5 ％ (25/40) and 92.5 ％ (37/40),respectively;the total effective rate in the observation group was significantly higher than that in the control group(x2 =12.381,P ＜0.05).The incidence of postoperative complications in the control group and observation group was 25.0％ (10/40) and 10.0％ (4/40),respectively;the incidence of postoperative complications in the observation group was significantly lower than that in the control group(x2 =11.140,P ＜ 0.05).Conclusion Intervertebral finite fenestration can effectively reduce lumbar pain,improve the lumbar function of patients with LIDP complicated with spinal stenosis;and it has fewer postoperative complications.