2018 年第 3 期 第 13 卷

选择性减压联合固定术对Ⅰ及Ⅱ度退行性滑脱腰椎管狭窄的疗效观察

Effect of selective decompression combined with fixation on lumbar spinal stenosis with grade Ⅰ/Ⅱ degenerative spondylolisthesis

作者：王祥强苗峰卜志勇

英文作者：

单位：442000湖北省十堰市，湖北医药学院附属人民医院脊柱外科

英文单位：

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• 摘要：

• 目的    探讨选择性减压联合固定术对Ⅰ、Ⅱ度退行性滑脱腰椎管狭窄患者的临床疗效。方法    选取2014年1月至2016年4月在湖北医药学院附属人民医院就诊的Ⅰ、Ⅱ度退行性滑脱的腰椎管狭窄患者85例作为研究对象，根据患者的退行性滑脱程度分为Ⅰ度滑脱组（44例）和Ⅱ度滑脱组（41例），对2组患者均采用选择性减压联合固定术治疗。采用疼痛视觉模拟量表（VAS）、Oswestry功能障碍指数（ODI）评分标准、日本骨科协会（JOA）腰痛评分标准、世界卫生组织生存质量测定量表、焦虑自评量表（SAS）和抑郁自评量表（SDS）分别对2组患者手术前及术后6个月的疼痛程度、腰椎功能障碍指数、脊髓神经功能情况、生活质量、焦虑和抑郁症状进行评价。结果    2组患者术后6个月的VAS评分和ODI评分均明显低于手术前，且Ⅰ度滑脱组明显低于Ⅱ度滑脱组（均P<0.01）；2组术后6个月JOA评分均明显高于手术前［Ⅰ度滑脱组：（24.0±2.4）分比（9.4±1.0）分；Ⅱ度滑脱组：（16.7±2.1）分比（9.4±0.8）分］，且Ⅰ度滑脱组明显高于Ⅱ度滑脱组（均P<0.01）。2组患者术后6个月SAS及SDS评分以及心理领域、生理领域、环境领域及社会关系领域的评分均高于手术前，且Ⅰ度滑脱组明显高于Ⅱ度滑脱组（均P<0.01）。结论    选择性减压联合固定术对Ⅰ、Ⅱ度退行性滑脱的腰椎管狭窄患者均有良好的疗效，但选择性减压联合固定术对Ⅰ度退行性滑脱所致腰椎管狭窄患者的疗效明显优于Ⅱ度退行性滑脱患者。

• Objective    To investigate the effect of selective decompression combined with fixation on lumbar spinal stenosis with grade Ⅰ/Ⅱ degenerative spondylolisthesis. Methods    Eighty-five patients with lumbar spinal stenosis due to degenerative spondylolisthesis were enrolled from January 2014 to April 2016 in Renmin Hospital, Hubei University of Medicine; according to the degree of degenerative spondylolisthesis, they were divided into grade Ⅰ group（44 cases） and grade Ⅱ group（41 cases）. All patients had selective decompression combined with fixation surgery. Pain Visual Analogue Scale（VAS）, lumbar Oswestry disability index（ODI）, Japanese Orthopedic Association（JOA） spinal cord function standards, World Health Organization quality of life score, Self-rating Anxiety Scale（SAS） and Self-rating Depression Scale（SDS） were evaluated before and 6 months after surgery. Results    Six months after surgery, scores of VAS and ODI were significantly lower than those before surgery; scores of VAS and ODI in grade Ⅰ group were significantly lower than those in grade Ⅱ group（P<0.01）. Score of JOA after surgery were significantly higher than that before surgery［grade Ⅰ group： （24.0±2.4）points vs （9.4±1.0）points； grade Ⅱ group： （16.7±2.1）points vs （9.4±0.8）points］; score of JOA in grade Ⅰ group was significantly higher than that in grade Ⅱ group（P<0.01）. Scores of SAS, SDS, mental health, physical health, environment and social relationship after surgery were significantly higher than those before surgery; the scores in grade Ⅰ group were significantly higher than those in grade Ⅱ group（P<0.01）. Conclusions    elective decompression combined with fixation has a better curative effect on lumbar spinal stenosis with grade Ⅰ degenerative spondylolisthesis than grade Ⅱ degenerative spondylolisthesis.