不同术式治疗短节段腰椎管狭窄症效果随访分析

关键词：腰椎  椎管狭窄  融合器  脊柱融合术

Keywords:lumbar  spinal canal stenosis  cage  spinal fusion

摘要：

      目的：比较不同腰椎手术方式治疗短节段椎管狭窄的临床效果。 方法：回顾性分析65例经融合内固定术治疗的短节段椎管狭窄患者资料，其中行后外侧融合内固定术（PLF术）17例，后方腰椎椎间融合内固定术（PLIF术）48例，平均随访时间20.55个月。对患者术前及随访时症状进行JOA评分，不同术式手术出血量、手术时间、术前及随访时JOA评分改善程度、术后下腰痛发生率和手术节段融合效果进行统计学分析。结果：PLF组和PLIF组患者随访时JOA评分较术前均有改善，手术时间无显著差异，出血量有显著性差异，而PLF术组与PLIF术组患者在JOA评分改善量无显著性差异，术后下腰痛发生率无显著性差异。PLIF组随访的39例患者中，植骨达到100%融合，PLF组随访的12例患者中，确切融合达到41.67%，可能融合占58.33%。结论：PLF术、PLIF术均能有效的改善短节段椎管狭窄患者的临床症状，达到有效融合，短期随访中，PLF术在患者症状改善情况上与PLIF术相近，融合效果较PLIF术差，PLF术的手术时间与PLIF术接近，出血量少于PLIF术。

Abstract:

      Objective：To compare the clinical outcome of the treatment of different operation procedures in the treatment of short segment lumbar stenosis Method：The clinical records of 65 patients with short-segmental lumbar stenosis treated by fusion techniques with internal fixation were investigated retrospectively. The mean follow-up time was 20.55 months. The change of JOA score between pre-operation and post operation, operation time, blood loss, the incidence of low back pain and fusion effects in radiographs were checked by statistic method. Result：The JOA scores of 65 patients between pre-operation and post operation was not statistically significant， the improvement quantity of JOA score between the PLF and PLIF group shows no statistical difference, the operation time and total blood loss between the two groups were checked by independent t test and the latter was statistically significant， the incidents of low back pain after operation of the two groups was not significant. In the 39 available radiographs of PLIF group, the fusion rate is 100% and in the 12 radiographs of PLF group, the fusion rate was 41.67%, and the possible fusion rate was 57.33%. Conclusion：Combined with bilateral internal fixation, PLF and PLIF techniques are both effective treatment to short-segmental lumbar stenosis to achieve symptom relieve and solid fusion， In short-period follow-up, the degree of symptom relieve of PLF technique is similar to that of PLIF technique, and the fusion rate of PLF technique is lower than PLIF technique， the operation time is similar between the two treatments, however the total blood loss is statistically larger in PLIF than in PLF process.