单纯性腰椎管狭窄症手术方法比较

目的 比较单纯性腰椎管狭窄症的手术方法，并介绍棘突截骨椎管成形术的临床应用。方法 对48例单纯性腰椎管狭窄症患者分组进行椎板切除术，椎板开窗术和棘突截骨椎管成形术，术后进行Oswestry疗效评分和影像学观察。结果 术后1年疗效优良率椎板切除组为81.9%，椎板开窗组为79.7%，椎管成形组为82.1%，疗效优良率各组无显著差别，术后4年疗效优良率椎板切除组为74.3%，椎板开窗组为78.2%。椎管成形组为80.4%。术后4年椎板切除组疗效下降显著，椎板开窗组和椎管成形组疗效下降不显著，术后1年所有患者X线检查未显示腰椎不稳定，术后4年X线显示有5名患者腰椎不稳定或退行性滑脱，其中椎板切除组3例，椎板开窗组和椎管成形组各1例。结论 椎板切除术，椎板开窗术，椎管成形术治疗单纯性腰椎管狭窄，3组术后近期疗效均满意，术后中期评估表明椎管成形术和椎板开窗术优于椎板切除术，后者腰椎不稳定和交界处再狭窄发生率较高。

A comparative study of the surgical techniques for the treatment of simple lumbar spine stenosis

Objective:To compare surgical techniques for the treatment of simple lumbar stenosis and to describe a new procedure of canaloplasty Methods:Laminectomy,laminotomy and canaloplasty were performed in 48 patients.The surgical outcomes were evaluated with Oswestry Disability Index and radiological findings from one to four yearsResults:The satisfactory clinical results was achieved in 81.9% patients of undergone laminectomy group,79.7% of laminotomy group,and 82 1% of canaloplasty group were followed up one year after surgery.The satisfactory clinical result was dropped to 74.3% in laminectomy group,however the results were not changed in the laminotomy and canaloplasty groups four years after surgery.Conclusion:Short term outcomes of laminectomy,laminotomy and canaloplasty for simple stenosis of lumbar spine were equally satisfactory.Medium term outcomes was better in canaloplasty and laminotomy group,and fair in laminectomy group with clinical and radiological following up.