CAJ | 학술논문

目的：分析减压融合手术与传统减压手术治疗复杂型腰椎管狭窄症的临床疗效。方法127例复杂型腰椎管狭窄症患者,按手术方法不同分为2组,减压组60例采用单纯椎板间开窗减压术,减压融合组67例采用椎板切除减压及椎间植骨融合内固定手术。比较两组患者JOA评分和VAS评分情况。结果127例均获得随访,时间2年。 JOA评分：减压组术前为13．46分±1．85分,术后2年为23．86分±1．71分,差异有统计学意义(P<0．05)；减压融合组术前为13．72分±1．69分,术后2年为24．60分±1．55分,差异有统计学意义(P<0．05)。术后JOA改善率减压组为66．92%±8．03%,减压融合组为71．20%±7．83%,差异无统计学意义(P>0．05)。术后2年VAS评分：减压组为3．85分±1．05分,减压融合组为2．26分±1．54分,减压融合组低于减压组(P<0．05)。椎间隙高度：减压组术前为6．4 mm ±2．6 mm,术后2年为5．3 mm ±1．8 mm,差异有统计学意义(P<0．05)；减压融合组术前为6．2 mm ±2．9 mm,术后2年为7．1 mm ±1．6 mm,差异有统计学意义(P<0．05)。滑脱程度：减压组术前为16．3%±5．2%,术后2年为15．4%±3．0%,差异无统计学意义(P>0．05)；减压融合组术前为17．3%±4．9%,术后2年为12．6%±5．8%,差异有统计学意义(P<0．05)。结论减压融合手术与单纯减压手术治疗腰椎管狭窄症早期疗效相当,但术后2年临床症状改善情况较单纯减压手术效果更好。
목적：분석감압융합수술여전통감압수술치료복잡형요추관협착증적림상료효。방법127례복잡형요추관협착증환자,안수술방법불동분위2조,감압조60례채용단순추판간개창감압술,감압융합조67례채용추판절제감압급추간식골융합내고정수술。비교량조환자JOA평분화VAS평분정황。결과127례균획득수방,시간2년。 JOA평분：감압조술전위13．46분±1．85분,술후2년위23．86분±1．71분,차이유통계학의의(P<0．05)；감압융합조술전위13．72분±1．69분,술후2년위24．60분±1．55분,차이유통계학의의(P<0．05)。술후JOA개선솔감압조위66．92%±8．03%,감압융합조위71．20%±7．83%,차이무통계학의의(P>0．05)。술후2년VAS평분：감압조위3．85분±1．05분,감압융합조위2．26분±1．54분,감압융합조저우감압조(P<0．05)。추간극고도：감압조술전위6．4 mm ±2．6 mm,술후2년위5．3 mm ±1．8 mm,차이유통계학의의(P<0．05)；감압융합조술전위6．2 mm ±2．9 mm,술후2년위7．1 mm ±1．6 mm,차이유통계학의의(P<0．05)。활탈정도：감압조술전위16．3%±5．2%,술후2년위15．4%±3．0%,차이무통계학의의(P>0．05)；감압융합조술전위17．3%±4．9%,술후2년위12．6%±5．8%,차이유통계학의의(P<0．05)。결론감압융합수술여단순감압수술치료요추관협착증조기료효상당,단술후2년림상증상개선정황교단순감압수술효과경호。
Objective To analyze the clinical efficacy of traditional decompression and fusion surgery for complex lumbar spinal stenosis. Methods 127 cases of complex patients with lumbar spinal stenosis were divided into two groups according to surgical methods. 60 patients of decompression group were used for interlaminar fenestration de-compression;decompression and fusion using laminectomy group of 67 cases of decompression and interbody fusion and internal fixation. JOA scores and VAS scores were compared between two groups. Results 127 cases were fol-lowed up for 2 years. JOA scores:preoperative decompression group was 13. 46 ± 1. 85 points, 23. 86 ± 1. 71 points after 2 years, the difference was statistically significant ( P<0. 05 ); decompression and fusion group preoperatively 13. 72 ± 1. 69 points, after 2 years of 24. 60 ± 1. 55 points, the difference was statistically significant ( P<0. 05 ) . The improvement rate of JOA at postoperation for decompression comparison was 66. 92% ± 8. 03%, decompression and fusion group was 71. 20% ± 7. 83%, the difference was not statistically significant (P>0. 05). VAS score after 2 years decompression group was 3. 85 ± 1. 05 points, decompression and fusion group was 2. 26 ± 1. 54 points, de-compression and fusion group after 2 years was significantly lower VAS scores circumstances decompression group ( P<0. 05). Invasive surgery intervertebral height:preoperative decompression group was 6. 4 mm ± 2. 6 mm,5. 3 mm ± 1. 8 mm after 2 years,the difference was statistically significant (P<0. 05);decompression and fusion group preoper-atively 6. 2 mm ± 2. 9 mm,after 2 years of 7. 1 mm ± 1. 6 mm,the difference was statistically significant (P<0. 05). Slip rate:preoperative decompression group was 16. 3% ± 5. 2%,15. 4% ± 3. 0% after 2 years,showed no significant difference ( P>0. 05 );decompression and fusion group preoperatively 17. 3% ± 4. 9%, after 2 years of 12. 6% ± 5. 8%,the difference was statistically significant ( P<0. 05 ) . Conclusions Decompression and fusion surgery and conventional surgical treatment are effective for lumbar spinal stenosis in the short term, but it is better at 2 years fol-low-up in improvement of clinical symptoms than traditional decompression surgery.