| Objective: By comparing the curative effect and fusion rate of internal fixation and fusion after hemilaminar decompression and total laminar decompression,the advantages and disadvantages,feasibility and reliability of the two surgical methods were discussed,and the clinical reference was provided.Methods: In this study,the preoperative and postoperative control and parallel control research methods were used to retrospectively analyze 83 patients（83 vertebral bodies）admitted to the Department of Spinal Surgery,these patients from Dali Bai minority Autonomous Prefecture People’s Hospital in June 2019-June 2021 in Yunnan Province.Complete X-ray（frontal and lateral lumbar spine,hyperextension and hyperflexion）,lumbar spine CT scan and magnetic resonance imaging（MRI）,A total of 83 cases were included in strict accordance with the standard,of which 42 cases underwent total laminar decompression followed by bone graft fusion and internal fixation（group A）.In addition,single-segment decompression,bone grafting,fusion and internal fixation were performed in the hemilaminar group（group B）,with 41 cases.The blood loss and operation time of the patients were recorded during the operation.The drainage volume and hospitalization days of the two groups were counted after operation,and all patients were interviewed for 1 month,6 months and12 months respectively after operation.The pain level of patients during the follow-up period before and after surgery was evaluated using the Visual Analogue Scale（VAS）and the Japanese Orthopaedic Association（JOA）scale.Disability index（ODI）was used to evaluate the functional status of the lumbar spine at each observation point before and after surgery in the two groups of patients,and statistical analysis was performed.The fusion rate at postoperative follow-up was evaluated and recorded.SPSS25.0 was used to analyze the data to compare the clinical efficacy,functional recovery,interbody fusion and complications.Results: All patients successfully completed the operation.In terms of operation conditions,the operation time: the operation time of group A was（113.40±9.16）minutes longer than that of group B（103±15.41）minutes,comparing between the groups,their results are statistically different（P<0.05）;In terms of blood loss: the intraoperative blood loss of group A was（355.00±44.74）ml more than that of group B（266.34±40.48）ml,comparing between the groups,their results are statistically different（P<0.05）;In postoperative drainage: Draining fluids after surgery of group A was（345.36±41.27）ml more than that of group B（266.34±40.48）ml,comparing between the groups,their results are statistically different（P<0.05）;post-operative hospital stay,post-operative hospital stay in group A（12.26±2.55）d were higher than those in group B（10.83±2.46）d,comparing between the groups,their results are statistically different（P<0.05）.On the clinical efficacy,the VAS,ODI,and JOA scores of the two groups of patients were greaterly improved at each time point of 1 month,6months,and 12 months comparison before and after surgery（P<0.05）.At the time points of 1 month and 6 months after the operation,the comparison of VAS,JOA and ODI scores between the groups was statistically significant（P<0.05）,and at the other time points,comparing between the groups,their results are statistically different（P<0.05）.In terms of imaging data: the lumbar lordosis angle（LL,Lumbar lordosis angle）of the two groups increased compared with that before operation,and the difference was statistically significant（P>0.05）,and the postoperative hemilaminar group B（48.83 °±9.56°）was more significant than that of the full lamina group A（45.56°±10.89°）.Comparing between the groups,,the difference was statistically significant（P<0.05）.The fusion rates were 35.7% and 69.0%,respectively.The fusion rates of group B were 61.0% and 87.8% at the time points of January and June,respectively.The fusion rate of group B was significantly higher than that of group A,comparing between the groups,their results are statistically different（P<0.05）,the fusion rates of group A and group B were 97.62% and 100% respectively at the12-month follow-up.The comparison between groups was not statistically significant.Concluusions: Fusion and internal fixation after decompression of hemilaminar and full laminar can improve the pain and quality of life of patients to a certain extent,and both have the same clinical efficacy in the long run.However,in terms of operation time,intraoperative bleeding,postoperative drainage,and postoperative hospitalization days,the hemilaminar group has the advantages of reduced surgery’s time,less tissue trauma,and easy postoperative recovery.Posterior ligament complex（PLC,Posterior ligament complex）preserves the physiology of the posterior column more,indicating that the hemilaminus group is better than the full lamina group in terms of short-term postoperative lumbar functional recovery.There are certain advantages in the short term. |
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