腰椎椎管狭窄症的外科治疗

目的探讨腰椎椎管狭窄症外科治疗的临床疗效。方法回顾性研究手术治疗退变性腰椎椎管狭窄患者共172例,其中10例有脊柱侧凸改变,22例Ⅰ～Ⅱ度滑脱。单节段狭窄者90例,双节段狭窄者51例,3个节段狭窄者31例。采用单纯开窗减压者5例,后路融合固定者100例,后路椎间融合固定62例,Dynesys弹性内固定5例。临床疗效评定采用疼痛视觉模拟量表（visual analogue scale,VAS）评分,功能评分采用北美脊柱外科学会改良腰椎功能障碍指数（modified Oswestry low back pain disability questionaire index,MODI）,从腰腿痛、生活自理、行走和举重物等10个方面评估患者腰椎的ODI分数。结果所有病例随访6～72个月,平均50个月。术前腰腿痛平均评分为7.5分,术后3个月为3.2分,末次随访时为3.6分。术后3个月随访,MODI改善的优良率为94.3%;末次随访时优良率为87.6%。结论对退行性腰椎椎管狭窄根据术前临床及影像学检查,有针对性地进行椎管减压或联合椎弓根螺钉内固定治疗均可取得较好疗效。

Surgical treatment of lumbar spinal canal stenosis

Objective To evaluate the clinical outcomes of surgical treatment for the patients with degenerative lumbar spinal stenosis（DLSS）.Methods A retrospective study was conducted with a total of 172 DLSS patients who underwent decompression surgery with or without arthrodesis.The patients included 90 with single segment stenosis,51 with double stenoses,and 31 with triple stenosis.Ten of the patients also had scoliosis and 22 had Ⅰ-Ⅱ degrees of spondylolysis.Five patients underwent simple decompression,100 patients underwent posterior spinal fusion and fixation,62 underwent posterior spinal fusion and fixation,and 5 underwent Dynesys semirigid fixation.The symptom relief and function improvement were assessed with a visual analogue scale（VAS） and modified Oswestry low back pain disability questionaire index（MODI）,respectively.Results The patients were followed-up for 6-72 months,a mean of 50 months after operation.The mean VAS score was 7.5 before operation,3.2 at 3 months after operation,and 3.6 at the final follow-up.The rate of excellent and good outcomes according to MODI scores was 94.3% at 3 months after operation and 87.6% at the final follow-up.Conclusion Based on preoperation image diagnosis,DLSS patients can be well treated by decompression or decompression with arthrodesis.