“开窗技术” 治疗退性腰椎管狭窄症融合指征.docVIP

“开窗技术”治疗退行性腰椎管狭窄症融合指征 陈远明 靳安民 张辉 朱立新 闵少雄 张力 作者单位：510282 广州，南方医科大学附属珠江医院骨科中心 陈远明，Tel E-mail:chenyuanming07bo@163.com. 通信作者：靳安民, Tel?; E-mail: jinanmin123@163.com 【摘要】目的 探索初次“开窗技术”治疗退行性腰椎管狭窄症融合的指征。方法 对1999年12月至2005年12月间连续收治的145例患者，进行回顾性研究。按术前腰椎条件及手术方法分三组：A组，术前合并腰椎失稳运动、退变性滑脱或侧弯，行融合术，共39例；B组，术前合并腰椎失稳运动、退变性滑脱或侧弯，行非融合术，共31例；C组，术前无腰椎失稳运动、退变性滑脱或侧弯，行非融合术，共75例。对患者病历进行复习，通过电话和门诊复诊方式进行随访。统计住院天数、手术时间、估计出血量等；观察复发、再手术及并发症情况等；采用Oswestry功能障碍指数和疼痛视觉模拟评分及满意率等进行疗效评估，应用SPSS 13.0软件进行统计。结果 每组至少随访3年以上，C组的住院天数少于A、B组（P＜0.05）；A组的手术时间和估计出血量大于B、C组（P＜0.05）； A、C组长期疗效好于B组（P＜0.05）, A、C两组间无明显差异；三组间的复发或残余症状恶化、再手术及并发症等方面没有显著差异。结论 术前合并腰椎失稳运动、退变性滑脱或侧弯的退变性腰椎管狭窄症患者，即使初次行创伤小的“开窗技术”减压，也应融合；单纯狭窄的患者初次手术，则无需融合。 【关键词】椎管狭窄症；退行性；融合；指征；开窗技术 Indication of Fusion for Degenerative Lumbar Spinal Stenosis Treated by“Windows Technique” Laminoforaminotomy CHENG Yun-ming, JIN An-min, ZHANG Hui, ZHU Li-xin, MIN Shao-xiong, ZhANG Li. Department of Orthopaedic Surgery, Zhujiang Hospital Southern Medical University, Guangzhou 510282, China 【Abstract】Objective To explore the primary Window Technique treatment of degenerative lumbar spinal stenosis fusion indications. Methods From December 1999 to December 2005, 145 consecutive patients who were treated by primary decompression with “Windows Technique” laminoforaminotomy for degenerative lumbar spinal stenosis, a retrospective study, were divided into 3 groups (A and B and C) by preoperative lumbar conditions and surgical methods. In group A, 39 patients with spinal instability or degenerative lumbar spondylosithesis or scoliosis underwent decompression and fusion; In group B, 31 patients with spinal instability or degenerative lumbar spondylosithesis or scoliosis underwent decompression alone; In group C, 75 patients without spinal instability or degenerative lumbar spondylosithesis or scoliosis were treated by decompression without fusion. On hospital medical records to review, they were followed up by telephone and out-patient referral. Sta