保留棘上韧带连续性的椎板回植、神经根管扩大术治疗腰椎退变疾病

来源 :中华医学杂志 | 被引量 : 0次 | 上传用户:pc167
下载到本地 , 更方便阅读
声明 : 本文档内容版权归属内容提供方 , 如果您对本文有版权争议 , 可与客服联系进行内容授权或下架
论文部分内容阅读
目的:探讨保留棘上韧带连续性的椎板回植、神经根管扩大术治疗腰椎退变疾病的临床疗效。方法:回顾性分析2016至2018年漯河市中心医院行手术治疗的腰椎退变疾病患者的资料,根据手术方式的不同分为两组。采用超声骨刀行保留棘上韧带连续性的椎板回植、腰椎间盘切除、神经根管扩大术的为治疗组(17例),采用全椎板切除、神经根管扩大、椎间盘切除、椎间融合内固定术(PLIF)的为对照组(28例)。所有患者术后平均随访17.8个月(12~27个月)。应用日本骨科协会(JOA)腰痛29分评分标准和疼痛视觉模拟评分(VAS)对两组手术前后临床疗效进行主、客观比较评价;采用腰椎动力位片及测量腰椎Cobb角进行影像学评价,记录末次随访时相邻节段退变(ASD)发生情况。结果:两组患者术前JOA评分、VAS评分及腰椎Cobb角差异均无统计学意义(均n P>0.05)。治疗组手术时间较对照组缩短,术中出血量亦较对照组减少,术后卧床时间亦较对照组短[(79±14)比(118±17) min、(151±38)比(324±70)ml和(3.4±0.7)比(4.3±1.0)d,n t=-8.508、-10.724、-3.244,均n P<0.01]。与对照组相比,治疗组术后引流量也明显减少(n t=-5.637,n P0.05),而治疗组VAS评分优于对照组(n P<0.05)。与对照组相比,术后1年治疗组腰椎Cobb角明显增加(55.3°±3.2°比38.4°±6.2°,n t=10.391,n P0.05). The operation time in the treatment group was shorter than that in the control group, and the blood loss during operation in the treatment group was lower than that in the control group, the bed rest time of the treatment group after operation was shorter than that in the control group ((79±14) vs (118±17) min, (151±38) vs (324±70) ml and (3.4±0.7) vs (4.3±1.0) d,respectively;n t=-8.508, -10.724, -3.244, all n P<0.01). In addition, compared with the control group, the volume of postoperative drainage in the treatment group also decreased significantly (n t=-5.637, n P0.05), but there was significant difference in VAS score between the two groups, the treatment group was better than the control group (n P<0.05). Compared with the control group, the lumbar Cobb angle in the treatment group increased significantly one year after the operation (55.3°±3.2° vs 38.4°±6.2°,n t=10.391, n P<0.05). During the follow-up, no loosening or fracture of the implants was found in all patients.n Conclusion:Treatment of lumbar degenerative diseases with recapping laminoplasty and nerve root canal′s decompression preserving the continuity of supraspinous ligament by ultrasound osteotome has the same clinical effect as PLIF. It has the advantages of shortening operation time, less bleeding, better maintenance of lumbar lordosis after operation and reduction of adjacent segment degeneration.
其他文献