椎板切除术和椎板切开术治疗腰椎管狭窄症的功能预后
Functional outcomes of laminectomy and laminotomy for the surgical management lumbar spine stenosis.
作者信息
Williams Mark G, Wafai Ahmad M, Podmore Malcolm D
机构信息
Department of Trauma and Orthopaedics, North Devon District Hospital, Raleigh Park, Barnstaple, Devon, UK.
出版信息
J Spine Surg. 2017 Dec;3(4):580-586. doi: 10.21037/jss.2017.10.08.
BACKGROUND
This clinical descriptive study aims to establish if differences exist in functional outcomes, to include both leg and lower back pain (LBP) as well as disability, in patients undergoing laminectomy or laminotomy surgery for lumbar spinal stenosis (LSS).
METHODS
We conducted a single centre, prospective study of 119 patients undergoing laminectomy or laminotomy surgery for LSS, from 2006 and 2012. Clinical outcomes for back and leg pain were analyses using Oswestry Disability Index (ODI) questionnaires and visual analogue scale (VAS) scores collected preoperatively, at 6 weeks and 1 year. Further analysis subdivided patients into two groups based on initial LBP VAS scores.
RESULTS
Fifty-five percent of patients were females (n=65) and 45% males (n=54), with a mean age of 68.7 years and L4/5 being the level most frequently decompressed. Considering all surgeries, a statistically significant reduction in VAS back pain between pre-op and 6 weeks was seen (4.99 to 3.00, P<0.001). There was a significant (P<0.0001) average reductions in LBP by 1.66 units and leg pain by 3.33 units after 1 year, with minimal difference between laminectomy and laminotomy. In the VAS back ≥5 group, laminectomy patient's pain increased by 0.63 units between 6 weeks and 1 year whilst laminotomy patients experienced a reduction in back pain of 0.51 units (P=0.063). ODI scores significantly improved for laminectomy and laminotomy by an average of 19.1%, 95% CI: 13.4-24.9% and 10.8%, 95% CI: 5.8-15.7%, with no statistically significant difference between groups.
CONCLUSIONS
No statistically significant differences were demonstrated between laminectomy and laminotomy outcomes, for LBP, leg pain or disability in our institute. On the basis of functional outcomes laminectomy remains a feasible approach in the treatment of lumbar spine stenosis. The data presented in this manuscript provides frequency data for subsequent comparative studies.
背景
本临床描述性研究旨在确定接受椎板切除术或椎板切开术治疗腰椎管狭窄症（LSS）的患者在功能结局方面是否存在差异，包括腿部和下背部疼痛（LBP）以及残疾情况。
方法
我们对2006年至2012年间119例接受LSS椎板切除术或椎板切开术的患者进行了单中心前瞻性研究。使用Oswestry残疾指数（ODI）问卷和术前、6周及1年时收集的视觉模拟量表（VAS）评分分析背部和腿部疼痛的临床结局。进一步分析根据初始LBP VAS评分将患者分为两组。
结果
55%的患者为女性（n = 65），45%为男性（n = 54），平均年龄68.7岁，L4/5是最常减压的节段。考虑所有手术，术前至6周时VAS背部疼痛有统计学显著降低（4.99至3.00，P < 0.001）。1年后LBP平均显著降低1.66个单位，腿部疼痛平均降低3.33个单位，椎板切除术和椎板切开术之间差异最小。在VAS背部≥5组中，椎板切除术患者的疼痛在6周和1年之间增加了0.63个单位，而椎板切开术患者的背部疼痛减少了0.51个单位（P = 0.063）。椎板切除术和椎板切开术的ODI评分平均显著改善，分别为19.1%，95%CI：13.4 - 24.9%和10.8%，95%CI：5.8 - 15.7%，两组之间无统计学显著差异。
结论
在我们研究所，椎板切除术和椎板切开术在LBP、腿部疼痛或残疾方面的结局无统计学显著差异。基于功能结局，椎板切除术仍是治疗腰椎管狭窄症的可行方法。本手稿中呈现的数据为后续比较研究提供了频率数据。
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