【摘要】 目的探讨微创Wiltse入路手术治疗双节段腰椎管狭窄症伴神经根沉降征阳性患者的临床疗效。方法回顾性分析2014年3月至2016年3月揭阳市人民医院收治的118例双节段腰椎管狭窄症患者的临床资料,患者均采用微创Wiltse入路经椎间孔减压椎间融合术治疗。根据神经根是否沉降,分为沉降征阴性组(n=46)和沉降征阳性组(n=72)。记录两组患者手术时间、术中出血量、术后引流量及并发症发生情况,采用视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)评估两组患者术前及术后3个月疼痛程度和功能状况,根据Macnab疗效评定标准评估两组临床疗效。结果两组手术时间、术中出血量和术后引流量比较,差异无统计学意义(P>0.05)。随访时间3~12个月,平均随访时间(6.8±2.5)个月。两组术后3个月VAS评分和ODI均明显低于术前(P<0.05);沉降征阳性组术后3个月VAS评分改善值、ODI改善值及Macnab疗效优良率分别为(5.0±1.0)分、(27.5±0.7)%、96%,显著高于阴性组的(4.6±0.9)分、(26.1±0.9)%、83%(P<0.05);两组术后并发症发生率无明显差异(P>0.05)。结论微创Wiltse入路手术治疗双节段腰椎管狭窄症安全有效,尤其是对伴神经根沉降征阳性的患者疗效更佳,神经根沉降可能对预后具有一定的预测价值。更多还原

【Abstract】 Objective To discuss the clinical effects of minimally invasive Wiltse approach in treatment of lumbar spinal stenosis involving two segments complicated with positive nerve root sedimentation sign. Methods Clinical data of 118 patients with double-segment lumbar spinal stenosis treated from March 2014 to March 2016 in Jieyang people’s hospital, were retrospectively analyzed. All patients were accepted intervertebral foramen decompression and intervertebral fusion through minimally invasive Wiltse approach. According to the MRI examinations, patients were divided into negative sedimentation sign group(n = 46) and positive sedimentation sign group(n = 72). Operation time, intraoperative estimate blood loss, postoperative drainage volume and complications were recorded in two groups; Visual analogue scale(VAS) score and Oswestry disability index(ODI) before operation and 3 months after operation were evaluated, and clinical effects were accessed according to the Macnab efficacy evaluation criteria. Results The operation time, estimate intraoperative blood loss and postoperative drainage volume had no statistical significances between the two groups(P >0.05). Patients were followed up for 3-12 months, with an average of(6.8 ± 2.5) months. The VAS score and ODI notably reduced 3months after operation compared with preoperative ones(P <0.05). At 3 months after operation, the improvement value of VAS score, ODI and the excellent and good rate based on Macnab criteria in positive sedimentation sign group were(5.0 ± 1.0),(27.5 ± 0.7)% and 96%, but(4.6 ± 0.9),(26.1 ± 0.9)% and 83% in negative sedimentation sign group(P <0.05). When compared the incidence of postoperative complications in two groups,there was no statistical difference(P >0.05). Conlusions Minimally invasive surgery with Wiltse approach is a safe and effective therapeutic method in the treatment of lumbar spinal stenosis involving two segments,especially those cases with positive sedimentation sign, better effects could be obtained, this sign is also a good prognostic predictor.更多还原