Objective: To compare the effectiveness of posterior lumbar interbody fusion (PLIF) by unilateral fenestration and bilateral decompression with ultrasounic osteotome and traditional tool total laminectomy decompression PLIF in the treatment of degenerative lumbar spinal stenosis.
Methods: The clinical data of 48 patients with single-stage degenerative lumbar spinal stenosis between January 2017 and June 2017 were retrospectively analyzed. Among them, 27 patients were treated with unilateral fenestration and bilateral decompression PLIF with ultrasonic osteotome (group A), and 21 patients were treated with total laminectomy and decompression PLIF with traditional tools (group B). There was no significant difference in gender, age, stenosis segment, degree of spinal canal stenosis, and disease duration between the two groups ( P>0.05), which was comparable. The time of laminectomy decompression, intraoperative blood loss, postoperative drainage volume, and the occurrence of operation-related complications were recorded and compared between the two groups. Bridwell bone graft fusion standard was applied to evaluate bone graft fusion at last follow-up. Visual analogue scale (VAS) score was used to evaluate the patients' lumbar and back pain at 3 days, 3 months, and 6 months after operation. Oswestry disability index (ODI) score was used to evaluate the patients' lumbar and back function improvement before operation and at 6 months after operation.
Results: The time of laminectomy decompression in group A was significantly longer than that in group B, and the intraoperative blood loss and postoperative drainage volume were significantly less than those in group B ( P<0.05). There was no nerve root injury, dural tear, cerebrospinal fluid leakage, and hematoma formation during and after operation in the two groups. All patients were followed up after operation, the follow-up time in group A was 6-18 months (mean, 10.5 months) and in group B was 6-20 months (mean, 9.3 months). There was no complication such as internal fixation fracture, loosening and nail pulling occurred during the follow-up period of the two groups. There was no significant difference in VAS scores between the two groups at 3 days after operation ( t=1.448, P=0.154); the VAS score of group A was significantly lower than that of group B at 3 and 6 months after operation ( P<0.05). The ODI scores of the two groups were significantly improved at 6 months after operation ( P<0.05), and there was no significant difference in ODI scores between the two groups before operation and at 6 months after operation ( P>0.05). At last follow-up, according to Bridwell criteria, there was no significant difference in bone graft fusion between the two groups ( Z=-0.065, P=0.949); the fusion rates of groups A and B were 96.3% (26/27) and 95.2% (20/21) respectively, with no significant difference ( χ 2=0.001, P=0.979 ).
Conclusion: The treatment of lumbar spinal stenosis with unilateral fenestration and bilateral decompression PLIF with ultrasonic osteotome can achieve similar effectiveness as traditional tool total laminectomy and decompression PLIF, reduce intraoperative blood loss and postoperative drainage, and reduce lumbar back pain during short-term follow-up. It is a safe and effective operation method.
目的: 比较超声骨刀单侧开窗双侧减压后路腰椎椎体间融合术（posterior lumbar interbody fusion，PLIF）与传统工具全椎板切除减压 PLIF 治疗退变性腰椎管狭窄症患者的临床疗效。.
方法: 回顾分析 2017 年 1 月—6 月收治的 48 例单节段退变性腰椎管狭窄症患者临床资料，其中采用超声骨刀行单侧开窗双侧减压 PLIF 治疗 27 例（A 组），采用传统工具行全椎板切除减压 PLIF 治疗 21 例（B 组）。两组患者性别、年龄、狭窄节段、椎管狭窄程度、病程比较，差异均无统计学意义（ P>0.05），具有可比性。记录并比较两组患者椎板切除减压时间、术中出血量、术后引流量及手术相关并发症发生情况。末次随访时采用 Bridwell 植骨融合标准评估植骨融合情况。术后 3 d 及 3、6 个月采用疼痛视觉模拟评分（VAS）评估患者腰背部疼痛情况，术前及术后 6 个月采用 Oswestry 功能障碍指数（ODI）评分评估患者腰背部功能改善情况。.
结果: A 组患者椎板切除减压时间显著多于 B 组，术中出血量及术后引流量显著少于 B 组，差异均有统计学意义（ P<0.05）。两组患者均未出现神经根损伤、硬脊膜撕裂，术中、术后未出现脑脊液漏及血肿形成。两组患者术后均获随访，A 组随访时间为 6～18 个月，平均 10.5 个月；B 组为 6～20 个月，平均 9.3 个月。两组随访期间均未出现内固定物断裂、松动及拔钉等并发症。术后 3 d 两组 VAS 评分比较差异无统计学意义（ t=1.448， P=0.154）；术后 3、6 个月，A 组 VAS 评分显著低于 B 组（ P<0.05）。两组患者术后 6 个月 ODI 评分均较术前显著改善（ P<0.05），术前及术后 6 个月两组间 ODI 评分比较差异均无统计学意义（ P>0.05）。末次随访时根据 Bridwell 植骨融合标准，两组植骨融合情况比较差异无统计学意义（ Z=–0.065， P=0.949）；A、B 组植骨融合率分别为 96.3%（26/27）和 95.2%（20/21），比较差异无统计学意义（ χ 2=0.001， P=0.979）。.
结论: 采用超声骨刀单侧开窗双侧减压 PLIF 治疗腰椎管狭窄症，可获得与传统工具全椎板切除减压 PLIF 相似的临床疗效，同时能减少术中出血量和术后引流量，短期随访可降低腰背部疼痛程度，是一种安全有效的手术方式。.
Keywords: Ultrasonic osteotome; bilateral decompression; degenerative lumbar spinal stenosis; posterior lumbar interbody fusion; unilateral fenestration.