腰椎管狭窄症节段性减压后稳定结构重建术的随访观察

目的:探讨腰椎管狭窄症节段性减压后稳定结构重建术的远期疗效。方法:121例腰椎管狭窄症患者采用腰椎后正中切口,剥离一侧骶棘肌,切断棘突剥离对侧椎板,保留了棘上、棘间韧带和一侧组织的完整;手术中采用椎板间孔开窗减压,尽量保留腰椎后部结构骨性组织,切除导致狭窄的病理因素,将切断的棘突复位固定,重建脊柱后部结构。对接受随访的78例患者,应用JOA评分标准计算短期(术后3个月)及长期(8~13年)随访时的改善率和手术满意率并行影像学检查。结果:78例短期随访优72例,良5例,可1例,优良率为98·7%(77/78)。长期随访优62例,良12例,可3例,差1例,优良率为94·9%(74/78)。两者比较差异无显著性统计意义(P>0·05),长期随访时手术满意率为98·7%(77/78)。结论:节段性减压腰椎后稳定结构重建术有利于脊柱稳定性重建,显露范围广,椎管减压彻底,长期疗效肯定,值得临床推广使用。

Observation of long-term follow-up on the treatment for lumbar spinal stenosis with segmental decompression and reconstruction of posterior stable structure

Objective:To evaluate the long-term effect of the treatment for lumbar spinal stenosis with segmental decompression and reconstruction of posterior stable structure.Methods:A hundred and twenty-one patients with lumbar spinal stenosis were treated with operation.In lumbar posterior median did incision,stripping sacrospinalis muscle of one side,cutting spinous process and stripping vertebral lamina of the other side.The supraspinal ligament and interspinal ligament were completely kept.Trying to reserve posterior bone tissue of lumbar vertebrae,decompression by fenestration from the hole of vertebral lamina was adopted.We excised the pathological factors of stenosis,reposited and fixed the amputated spinous process and reconstructed posterior structure of spine.Seventy-eight patients were followed up with X-ray examination.The improving rate and satisfactory rate of short-term(3 months after operation)and long-term(8-13 years)were calculated with JOA score.Results:Short-term follow-up showed that 72 cases were excellent result,5 good and 1 fair.The rate of excellent and good was 98.7%(77/78).Long-term follow-up showed that 62 cases were excellent result,12 good,3 fair and 1 poor.The rate of excellent and good was 94.9%(74/78).There were no significant differences in the follow-up between short-term and long-term(P>0.05).In the long-term follow-up,the satisfactory rate of operation was 98.7%(77/78).Conclusion:The method provides wide exposure during operation,complete decompression and definite long-term result.It is beneficial to the reconstruction of spinal stability and is worthy in clinical application.