| Objective:Comparing the clinical efficacy between the preserved and non-retained ligament complex during the lumbar spinal canal decompression.Methods:Retrospective analysis of 60 patients with degenerative lumbar disease treated with lumbar spinal canal decompression or without the spinous process ligament complex in our hospital from June 2014 to June 2018.According to different surgical methods,they were divided into two groups:observation group(group A),30 cases with spinous process basal osteotomy and preservation of spinous process ligament complex,pedicle screw fixation for lumbar spinal tube expansion decompression;comparation group(group B),30 cases of lumbar canal enlargement decompression were not preserved by conventional surgical methods.All patients' basic information were collected including the age,gender,medical history time,body mass index,lesion segment,and symptoms.And we have also gathered the perioperative data including the operative time,intraoperative blood loss,postoperative drainage,and days of discharge.At last,preoperative and postoperative visual analogue scale(VAS)and functional index score(ODI)and Japanese Orthopaedic Association(JOA)scores were recorded in the two groups.All patients were followed up for 12?18 months,with an average of(15±2.4)months.X-ray examination of lumbar vertebrae was taken 1 day after surgery,6 months after operation and 1 year after operation.The intervertebral space and vertebral body slip distance of the upper and lower segments of the vertebral body were measured to adjuge the segmental vertebral body degeneration.All data were processed by SPSS 24.0 statistical software.The measurement data were expressed as mean±standard deviation(x±s).The t-test was used to compare the mean between the two groups.Variance analysis between any two groups in multiple sample means were compared using SNK-q test;counting data were expressed as percentage(%),analyzed by?2 test or corrected ?2 test;P<0.05 is on behalf of the difference,while P<0.01 means the significants difference statistically.Results:1 Comparison of general data between the two groupsThe patients in the two groups were compared in terms of age,gender,medical history,body mass index,lesion segment,symptoms,preoperative JOA,VAS,and ODI scores.The difference was not statistically significant(P>0.05).2 Comparison of perioperative indicators between the two groupsThere were no significant differences in the operation time,intraoperative blood loss and hospitalization time between the two groups(P>0.05).However,the drainage volume(515.0±209.7)ml in group B was significantly higher than that in group A(P>0.05).506.7±280.3)ml,the difference was statistically significant(P<0.05).3 Comparison of the effects in group A at different time3.1 JOA scores were compared between different time points(preoperative,6 months after surgery,1 year after surgery),the difference was statistically significant(FJOA=900.85,P<0.01);The JOA scores 6 months after surgery and that at 1 year[(25.90±1.81)and(24.60±1.70)]were significantly higher than those before surgery(8.60±1.50),and the differences were statistically significant(P<0.05).However,the 1 year after surgery JOA score(25.90±1.81)was similar to the 6 months after surgery postoperative(24.60±1.70),and the difference was not statistically significant(P>0.05).3.2 VAS score and ODI index were compared at different time points(preoperative,6 months after surgery,1 year after surgery),and the differences were statistically significant(FVAS=332.61 and FODI=944.11,both P<0.01);The VAS score and ODI index[(0.92±0.66)and(24.26±2.23)%vs(1.01±0.54)and(25.37±1.86)%]at 6 months after surgery and that at 1 year,Compared with preoperative[(7.07±1.55)and(50.17±3.47)%],the difference was statistically significant(P<0.05);but the VAS score and ODI index 1 year after surgery and that at 6 months after surgery,the results were similar and the difference was not statistically significant(P>0.05).4 Comparison of the effects in group B at different time4.1 JOA scores were compared between different time points(preoperative,6 months after surgery,1 year after surgery).The difference was statistically significant(FJOA=330.89?P<0.01);The JOA scores 6 months after surgery(21.50±2.21)and that at 1 year(18.53±2.47)were significantly higher than those before surgery(8.40±1.35),and the differences were statistically significant(P<0.05).To be noted that the 1-year JOA score(18.53±2.47)was significantly lower that 6 months after surgery(21.50±2.21),and the difference was statistically significant(P<0.05).4.2 VAS score and ODI index were compared at different time points(preoperative,6 months after surgery,1 year after surgery),and the differences were statistically significant(FVAS=477.91 and FODI=1007.35,both P<0.01);The VAS score and ODI index[(1.47±0.54)and(24.59±1.77)%vs(1.62±0.61)and(25.85±1.45)%]at 6 months after surgery and that at 1 year,Compared with preoperative[(7.40±1.22)and(50.92±3.80)],the difference was statistically significant(P<0.05);but the VAS score and ODI index 1 year after surgery and 6 months after surgery,the results were similar and the difference was not statistically significant(P>0.05).5 Comparison of the effect in these two groups at different time after operation5.1 Comparison of JOA score,VAS score and ODI index:At the 6-month follow-up,the VAS score and ODI index were compared between the two groups,and the differences were not statistically significant(tVAS=0.12 and tODI=0.62,both P>0.05);However,the JOA score(22.50±1.70)in group A was significantly higher than that in group B(18.53±2.47),the difference was statistically significant(t=8.44,P<0.01);1 year follow-up after operation At the time of VAS score and ODI index,the differences were not statistically significant(tVAS=1.01 and tODI=1.14,both P>0.05);however,the JOA score of group A(22.50±1.70)was significantly higher.In group B(18.53±2.47),the difference was statistically significant(t=7.24,P<0.01);5.2 Comparison of excellent rate of postoperative efficacy:The excellent rate of treatment(100%and 96.7%)in group A was significantly higher than that in group B(93.3%and 67.7%)at 6 months after surgery and 1 year follow-up.),the difference was statistically significant(?2=10.79,and ?2=11.51,both P<0.01).6 Comparison of postoperative complications between the two groupsAfter the operation,all patients' local pain and neurological symptoms were significantly relieved.There were 4 cases of cerebrospinal fluid leakage after operation,including 1 case in group A and 3 cases in group B.They were successfully healed by saline bag compression drainage tube,extended indwelling drainage tube time,closed drainage tube and other corresponding treatments.Occurred two cases of the Lumbar spondylolisthesis,and one case of secondary lumbar spinal stenosis,which all were in group B,and the symptoms were not obvious,no special treatment.All patients had no complications such as refractory low back pain,adjacent segment degeneration,pedicle loosening,spinous process ligament complex collapse,incisional hernia,nerve injury,wound infection or nonunion.The results showed that the postoperative complication rate in group A(3.3%)was significantly lower than that in group B(20%),and the difference was statistically significant(x2=2.356,P<0.05).Conclusion:Compared to the traditional lumbar spinal canal decompression with the removel of the spinous process ligament complex,the short-term effect of the preserved one is better,with less postoperative complications,therefore,the preservation of the spinous process ligament complex decompression should be a good choice for treatment of degenerative lumbar diseases,but its long-term efficacy still needs to be study further. |
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