椎弓根钉辅助下后外侧融合在退变性腰椎管狭窄症手术中的应用

目的探讨退行性腰椎管狭窄症(degenerativelumbarspinestenosisDLSS)的特点、椎弓根钉辅助下的后外侧融合手术要点及其在退变性腰椎管狭窄症减压术中的作用和意义。方法回顾性分析2000年1月～2003年12月间59例腰椎管狭窄症患者的临床症状、椎管减压和椎弓根钉辅助下的后外侧植骨融合的手术和术后随访情况,手术结果通过问卷式调查由患者进行自我评价,评价内容分为:腰痛、腿痛、日常活动水平、是否服用止痛药物四个方面进行。结果59例患者随访6～48个月,平均22.5个月,8例患者1年后失访。其中治疗效果优21例(35.6%),良32例(54.2%),可4例(6.8%),差2例(3.4%)。术中术后的并发症主要有:神经根损伤、硬膜囊撕裂、FBSS(FailedBackSurgerySyndrome)、ASD(AdjacentSegmentDisease)、椎弓根钉断裂等。结论DLSS包括多部位狭窄性病理改变,术中减压应当按照一定的步骤全面减压。椎弓根钉辅助后外侧融合可以提供腰椎即刻稳定,提高了远期融合率,使得滑脱椎体复位并保持椎间高度,减少椎管狭窄的进展和再发,从而提高手术的治疗效果。

Application of posterolateral fusion assisted with pedicle screw fixation in degenerative lumbar spine stenosis

Objective To expatiate on the characteristics of degenerative lumbar spine stenosis( DLSS) , and to probe into the effect and value of posterolateral fusion assisted with pedicle screw fixa-tion in the treatment of DLSS. Methods Retrospectively analyzed the symptom, operation and follow- updata of 59 cases of DLSS between Jan 2000 and Dec 2003. The operation included the process of decom-pression and posterolateral fusion assisted with pedicle screw fixation. The clinical outcome was obtainedthrough self- evaluation of the patients. The measures included the presence and severity back pain andleg pain as compared with that before surgery, the level of postoperation activity and the need for paincontrol medications. Results 59 cases were followed up for 6 months to 48 months, the average time offollow- up were 22.5 months, 8 cases lost follow- up after 12 months. The excellent outcome was attainedin 21 cases( 35.6%) , good in 32 cases( 54.2%) , fair in 4 cases( 6.8%) , and poor in 2 cases( 3.4%) . Themain peri- operative complications were nerve root injury and dural tear. The main long- dated postopera-tive complications were failed back surgery syndrome( FBSS) , adjacent segment disease( ASD) . and bro-ken of pedicle screw. Conclusion DLSS refers to stenotic pathological changes in multi- position. There-fore, the decompression should be comprehensive and in sequence. The operation of posterolateral fusionassisted with pedicle screw fixation could offer stabilization instantly, and improve the long- dated fusionrate. It also could preserve the height between the two vertebrae, and restrain the aggravation or recur-rence of lumbar stenosis. The clinical outcome would be improved finally.