Hu W, Zhao J, Gong C, Zou M, Yuan J H, Liu X Y
Department of Spinal Surgery, Bozhou People's Hospital, Anhui 236803, China.
Zhonghua Yi Xue Za Zhi. 2016 Jun 7;96(21):1673-6. doi: 10.3760/cma.j.issn.0376-2491.2016.21.012.
To compare the efficacy between unilateral laminectomy approach bilateral decompression and traditional total laminectomy decompression in the treatment of graft bone fusion and internal fixation for degenerative lumbar spinal stenosis with the unilateral symptoms.
From January 2013 to December 2014, a total of 40 patients with unilateral symptoms of lumbar spinal stenosis were treated in Department of Spinal Surgery Bozhou People's Hospital of Anhui Province. Twenty patients(group A ) were treated by severe symptoms unilateral facetectomy and resection of superior articular and laminectomy and lateral recess decompression, interbody fusion, pedicle screw fixation.Twenty patients(group B ) were treated by total laminectomy interbody fusion and pedicle screw fixation.The time of operation, blood loss of the two groups were recorded.At the same time the visual analog scale (VAS), Oswestry disability index(ODI), Japanese Orthopaedic Association Scores(JOA) before and after operation (3, 6 , 12months) were recorded retrospectively. The effect of surgery were evaluated and compared.
The VAS, JOA, and ODI of group A preoperation is respectively have no significant differences with the group B (P>0.05). The operation time, blood loss in operation of group A was respectively(133.2±25.3) min, (415.0±42.1) ml, significant differences with the group B[(491.0±46.3)ml; (156.2±28.5) min, P<0.05)]. The VAS, JOA, ODI of group A had no significant differences with the group B (P>0.05) at 3, 6 months after operation.The VAS, JOA, ODI of group A was respectively (3.0±0.6), (25.3±5.1), (16.5±1.5)scores, had significant differences with the group B and preoperation (P<0.05) at 12 months after operation. The radiographic data showed that the interbody fusion rate of group A was 100%, and group B was 95%, had significant differences by statistical analysis (P<0.05) at 12 months afer operation.
The improved unilateral laminectomy approach and bilateral decompression have less operation time and blood loss, more satisfactory for the lumbar spinal stenosis patients with the unilateral severe symptoms, the other side moderate stenosis and mild symptoms.The efficacy of lumbar stability and bilateral decompression is better by operation of improved unilateral approach.
比较单侧椎板切除术双侧减压与传统全椎板切除术减压在治疗伴有单侧症状的退变性腰椎管狭窄症植骨融合及内固定中的疗效。
2013年1月至2014年12月，安徽省亳州市人民医院脊柱外科共治疗40例伴有单侧症状的腰椎管狭窄症患者。20例患者（A组）采用严重症状侧单侧小关节突切除、上关节突及椎板切除及侧隐窝减压、椎间融合、椎弓根螺钉固定治疗。20例患者（B组）采用全椎板切除椎间融合及椎弓根螺钉固定治疗。记录两组的手术时间、失血量。同时回顾性记录两组患者术前及术后（3、6、12个月）的视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）、日本骨科学会评分（JOA）。对手术效果进行评估和比较。
A组术前VAS、JOA及ODI与B组相比差异均无统计学意义（P>0.05）。A组手术时间、术中失血量分别为（133.2±25.3）min、（415.0±42.1）ml，与B组相比差异有统计学意义[（491.0±46.3）ml；（156.2±28.5）min，P<0.05]。术后3、6个月，A组VAS、JOA、ODI与B组相比差异无统计学意义（P>0.05）。术后12个月，A组VAS、JOA、ODI分别为（3.0±0.6）分、（25.3±5.1）分、（16.5±1.5）分，与B组及术前相比差异有统计学意义（P<0.05）。影像学资料显示，术后12个月A组椎间融合率为100%，B组为95%，经统计学分析差异有统计学意义（P<0.05）。
改良单侧椎板切除术双侧减压手术时间短、失血量少，对于单侧症状严重、对侧中度狭窄且症状较轻的腰椎管狭窄症患者更为满意。改良单侧入路手术在腰椎稳定性及双侧减压方面疗效更好。
