CAJ | 학술논문

目的比较棘突劈开、单侧进入双侧减压与椎板切除、椎管减压治疗腰椎管狭窄症的疗效.方法前瞻性研究2009年6月至2010年5月手术治疗56例退变性腰椎管狭窄症或椎管狭窄合并间盘突出患者资料.术前随机将患者分为棘突劈开、单侧进入双侧减压组(简称棘突劈开组)及传统腰椎椎板切除、椎管减压组(简称椎板切除组).棘突劈开组共27例,男15例,女12例；年龄49～71岁,平均59.4岁.椎板切除组29例,男18例,女11例；年龄52～69岁,平均61.1岁.术后第3天行血肌酸激酶测定.应用日本矫形外科学会(Japanese Orthopaedic Association,JOA)腰痛评分及疼痛视觉模拟评分(visual analogue scale,VAS)作为手术前后主、客观评分标准.术后6个月CT扫描评价棘突愈合情况.测量术前及末次随访时多裂肌MR面积.结果棘突劈开组21例、椎板切除组24例获得2年以上有效随访.棘突劈开组术前腰痛及下肢痛VAS、JOA评分、多裂肌MR面积分别为:(5.6±1.7)分、(7.1±0.4)分、(11.6±2.6)分、(5.8±1.8)cm2；椎板切除组分别为(6.2±1.2)分、(7.9±1.3)分、(10.9±1.0)分、(6.1±2.0) cm2.棘突劈开组术后第3天血肌酸激酶测定值明显小于椎板切除组.棘突劈开组术后6个月随访时劈开棘突均完全愈合.末次随访时棘突劈开组下肢痛VAS、JOA评分及改善率分别与椎板切除组比较均无显著性差异.棘突劈开组腰痛VAS评分、多裂肌萎缩比分别为(1.0±0.5)分、6.4％±1.2％；椎板切除组分别为(2.6±0.7)分、l5.7％±3.0％,棘突劈开组均优于椎板切除组.两组动力位X线片均未见继发性腰椎不稳.结论棘突劈开、单侧进入双侧减压可有效减少手术创伤及术后腰痛发生率,保护双侧多裂肌棘突止点及对侧多裂肌在椎板的附着点.
목적 비교극돌벽개、단측진입쌍측감압여추판절제、추관감압치료요추관협착증적료효.방법 전첨성연구2009년6월지2010년5월수술치료56례퇴변성요추관협착증혹추관협착합병간반돌출환자자료.술전수궤장환자분위극돌벽개、단측진입쌍측감압조(간칭극돌벽개조)급전통요추추판절제、추관감압조(간칭추판절제조).극돌벽개조공27례,남15례,녀12례；년령49～71세,평균59.4세.추판절제조29례,남18례,녀11례；년령52～69세,평균61.1세.술후제3천행혈기산격매측정.응용일본교형외과학회(Japanese Orthopaedic Association,JOA)요통평분급동통시각모의평분(visual analogue scale,VAS)작위수술전후주、객관평분표준.술후6개월CT소묘평개극돌유합정황.측량술전급말차수방시다렬기MR면적.결과 극돌벽개조21례、추판절제조24례획득2년이상유효수방.극돌벽개조술전요통급하지통VAS、JOA평분、다렬기MR면적분별위:(5.6±1.7)분、(7.1±0.4)분、(11.6±2.6)분、(5.8±1.8)cm2；추판절제조분별위(6.2±1.2)분、(7.9±1.3)분、(10.9±1.0)분、(6.1±2.0) cm2.극돌벽개조술후제3천혈기산격매측정치명현소우추판절제조.극돌벽개조술후6개월수방시벽개극돌균완전유합.말차수방시극돌벽개조하지통VAS、JOA평분급개선솔분별여추판절제조비교균무현저성차이.극돌벽개조요통VAS평분、다렬기위축비분별위(1.0±0.5)분、6.4％±1.2％；추판절제조분별위(2.6±0.7)분、l5.7％±3.0％,극돌벽개조균우우추판절제조.량조동력위X선편균미견계발성요추불은.결론 극돌벽개、단측진입쌍측감압가유효감소수술창상급술후요통발생솔,보호쌍측다렬기극돌지점급대측다렬기재추판적부착점.
Objective To describe the technique and therapeutic effect of modified unilateral laminotomy for bilateral decompression (M-ULBD) for lumbar spinal stenosis (LSS).Methods A total of 56 patients with LSS were randomly divided into group A and B.The 27 patients in group A (15 males and 12 females,with an average age of 59.4 years) underwent M-ULBD.The other 29 patients in group B (18 males and 11 females,with an average age of 61.6 years) received conventional laminectomy.JOA score of low back pain,VAS,CPK three days after operation,pre-and post-operative cross-sectional areas of multifidus were used to evaluate the clinical results.Results A total of 45 patients (21 in group A and 24 in group B) completed 2 years of follow-up.The preoperative VAS of low back pain,leg pain,numbness,JOA score and cross-sectional areas of multifidus were 5.6±1.7,7.1±0.4,11.6±2.6,5.8±1.8 cm2 in group A and 6.2±1.2,7.9±1.3,10.9±1.0,6.1±2.0 cm2 in group B.There was no significant difference in preoperative data between both groups.The union of split spinous process was observed in all cases 6months later according to computed tomography.The postoperative CPK was lower in group A.The postoperative JOA and VAS scores in both groups were improved significantly compared with the corresponding preoperative ones.The VAS of leg pain,numbness,JOA score,and JOA recover rate in latest follow-up were 1.3±0.2,1.5±0.7,26.7±2.1,86.1％±3.1％ in group A,and 1.7±0.3,2.0±1.3,24.3±2.5,83.6％±6.4％ in group B,respectively.All these data have no difference between group A and B.The VAS of low back pain and atrophy rate of multifidus were 1.0±0.5,6.4％±1.2％ in group A,and 2.6±0.7,15.7％±3.0％ in group B respectively.All these data are lower in group A.Conclusion Our two years follow-up shows that this method is efficient for lumbar spinal stenosis treatment,however,it still need long term follow-up and to compare with other modified methods.