腰椎滑脱症的治疗分析

目的探讨腰椎滑脱症手术内固定、减压和植骨融合方式的选择及疗效。方法对37例腰椎滑脱患者进行三种手术方式治疗。a）单纯椎弓根钉固定复位、椎板间椎骨融合术16例;b）半椎板开窗减压、椎弓根钉固定椎板间植骨融合术或横突间植骨融合术14例;c）全椎板减压、椎弓钉固定、人工椎板或椎间植骨融合术7例。结果随访时间0．5～2年,平均16个月。无感染、神经根损伤,术后症状基本消失,植骨均融合,无固定螺钉松动、断裂及再滑脱现象。按照邹德威等标准评价疗效,A组：优13例,良1例,可2例,优良率88％;B组：优10例,良2例,可2例,优良率86％;C组：优4例,良2例,可1例,优良率86％。结论只要手术方案正确,术后效果均满意,三种方案无显著差异。     

双侧椎板开窗TFC腰椎融合术治疗下腰椎失稳症体会

目的应用双侧椎板开窗TFC椎间融合术治疗下腰椎失稳症的临床疗效观察。方法本组34例,男18例,女16例,年龄47～72岁,合并腰椎滑脱Ⅰ～Ⅱ3°例,均采取双侧椎板开窗以TFC(Treaded Fusion Cage)行PLIF椎间融合术,术中重视准确开窗、彻底减压和预防粘连等技术环节。结果平均随访16个月,术后1年X线片提示椎间融合率88.1,术后2年椎间融合率100%,功能恢复优良率97.1%。结论双侧椎板开窗TFC椎间融合术治疗下腰椎失稳症,既尽可能地保留了脊柱后柱、中柱结构,又能充分减压,可靠融合,达到有限手术入路和有效手术操作的有机统一,不失为一种比较理想的治疗下腰椎失稳的术式。     

退行性腰椎滑脱合并腰椎管狭窄症的手术策略和方法

目的 :评估椎管成形术、椎板减压融合术、减压融合固定术治疗退行性腰椎滑脱合并腰椎管狭窄症。方法 :16例稳定性腰椎滑脱患者接受棘突截骨椎管成形术 ,15例不稳定性腰椎滑脱患者接受椎板减压加后外侧融合术 ,14例不稳定性腰椎滑脱患者接受椎板减压椎间融合经椎弓根内固定术。术后进行疗效评分和影像学观察。结果 :术后 1年功能改善率 :椎管成形术为 85 .7% ,减压融合术为 84.8% ,固定融合术为 86.2 % ,各组疗效无显著差别 (P >0 .0 5 )。术后 4年功能改善率 :椎管成形术为 84.9% ,减压融合术为 75 .6% ,固定融合术为 84.6% ,减压融合术疗效下降显著 (P <0 .0 5 )。结论 :椎管成形术治疗稳定性腰椎滑脱 ,术后近中期疗效与影像学评估满意。椎板减压后外侧融合术治疗不稳定性腰椎滑脱 ,腰椎假关节发生率较高和术后中期疗效明显下降。椎板减压椎间融合内固定治疗不稳定性腰椎滑脱 ,术后中期疗效无明显改变     

退变性腰椎管狭窄症的诊断与手术治疗

目的　探讨退变性腰椎管狭窄症的诊断与手术治疗方式。方法　 1995～ 2 0 0 2年对 6 2例诊断为退变性腰椎管狭窄症的患者 ,仔细分型 ,采用 3种方法 ,a)开窗潜行扩大椎板减压术 ;b)扩大的半椎板切除减压术 ;c)全椎板切除加椎间融合术。结果　随访 1～ 6a ,按Nakal分级评定优 4 3例 ,良 16例 ,可 3例 ,优良率 96 .5 %。结论　退变性腰椎管狭窄症的手术治疗主要以充分彻底的减压、解除神经根的致压因素为主 ,但要兼顾减压的彻底性与腰椎的稳定性。单节段病变选择开窗潜行减压术或扩大半椎板切除减压术 ,多节段病变选择全椎板减压术同时行椎间融合术以保证腰椎稳定。     

开窗减压术治疗中央型腰椎管狭窄症

１９８６年以来，使用开窗减压术治疗中央型腰椎管狭窄症５３例，４９例（９２．５％）得到随访，优良率达９１．８％，仅有１例发生术后腰椎不稳。该手术损伤小，在较大程度上保留了腰椎后部结构均完整性，术后腰椎稳定性好，硬膜及神经根不易发生瘢痕粘连。虽然开窗减压范围小，但通过腰椎两侧对称性和多节段开窗，椎管可得到充分减压。临床应用表明该法较传统的椎板切除术疗效好。     

腰椎峡部裂并滑脱症的诊断与手术治疗

本文介绍36例腰椎峡部裂合并滑脱症诊断与手术治疗的经验。认为该病的诊断主要依赖于临床表现和腰椎X线检查。腰椎应力X线检查、CT及MRI检查均有助于手术治疗。手术包括腰椎板开窗减压、髓核摘除、复位、内固定和后外侧植骨融合术。内固定采用病椎峡部张力带固定和棘突间内固定。与其它内固定相比,具有手术创伤小,操作简单和稳固等优点。术后对32例病人进行了0.5～5.5年的随访观察,结果优24例,良5例,可3例;手术优良率达90.6％。     

老年人退行性腰椎管狭窄症诊断与手术治疗

目的：分析老年人退行性腰椎管狭窄症的发病机制，诊断和手术治疗。方法：对６２例退行性腰椎狭窄症病人进行了诊断与手术治疗。所有病人均接受了腰椎管减压术，全椎板减压４６例，半椎板减压１６例，１０例接受了开窗减压术。切除突出或膨出椎间盘５９例。７例病人因腰椎退行性滑脱而接受后外侧植骨融合术。结果：术后对４８例病人进行了１－４年的随访，平均２年，手术优良率为９３％。结论：作者认为腰椎ＣＴ扫描是该类病人安全而可靠的辅助检查。应注意该病与其它腰腿痛疾患的鉴别。腰椎减压术中应注意切除突出或膨出的椎间盘，同时应重建腰椎稳定性。术后应注意并发症的处理。     

腰椎微创手术器械在经椎间孔腰椎椎体融合术中的应用

目的 设计一套腰椎微创手术器械,并评估该器械在术中辅助经椎间孔腰椎椎体融合术(TLIF)进行腰椎翻修术的应用价值. 方法 设计一套腰椎微创手术器械,并于2010年11月至2011年11月采用该器械术中辅助TLIF完成腰椎翻修术24例,男14例,女10例;年龄38～77岁,平均56.4岁;其中腰椎间盘突出行单纯性椎板开窗减压髓核摘除术后12例,腰椎间盘突出伴腰椎不稳、腰椎滑脱行后路腰椎椎体融合术后8例,腰椎管狭窄后路椎板开窗减压术后4例;共融合34节段:L4-58例,L5S16例,L4-5和L5S1双节段4例,L3-4和L4-5双节段6例.比较患者手术前、后的Oswestry功能障碍指数问卷表(ODI)评分,采并用改良Macnab标准评定术后疗效. 结果 所有患者术后获6～18个月(平均13.0个月)随访,ODI评分由术前(70.7±12.3)分降至末次随访时(4.8±3.6)分,差异有统计学意义(t=29.564,P=0.000).临床疗效按改良Macnab标准评定:优19例,良5例,优良率为100％.患者手术切口均I期甲级愈合,无发生并发症. 结论 自行研发的腰椎微创手术器械辅助TLIF行腰椎翻修术,降低了手术风险,减少了术后并发症,具有临床推广应用价值.     

退行性腰椎滑移手术疗效的分析

目的：合理选择退行性腰滑移的手术方案。方法：对４６例退行性腰椎滑移术后疗效进行回顾性研究。分析减压方法、腰椎融合术及内固定对手术效果的影响。结果：①与双侧扩大开窗加融合术比较，全椎板切除加腰椎融合能取得较佳的临床疗效；②滑移后引起的腰椎管狭窄的类型可影响双侧椎板扩大开窗术的手术效果；③融合术再加内固定有助于提高手术疗效。总之：应根据受压病理状态来确定手术指征及手术中减压的范围，融合指数则有助于确定是否行腰椎融合术，在行融合术的病例应同时行内固定术。     

通用型脊柱内固定系统治疗腰椎滑脱

目的探讨国产通用型脊柱内固定系统手术治疗腰椎滑脱的疗效。方法采用椎板开窗减压或保留棘突的全椎板切除减压，国产通用型脊柱内固定系统（All Fix或GSS-Ⅱ）固定，椎体间植骨融合术治疗腰椎滑脱45例。结果19例完全复位，26例部分复位。术后随访39例，随访时间平均3．5年，优良率84．6％。结论国产通用型脊柱内固定系统结构简单，操作方便，固定坚固，能使滑脱的椎体复位，明显提高脊椎融合率。     

保留棘突韧带复合结构椎管潜行减压治疗退变性腰椎管狭窄症

目的探讨保留棘突韧带复合结构椎管潜行减压治疗退变性腰椎管狭窄症的疗效。方法回顾采用保留棘突韧带复合结构椎管潜行减压方法治疗的87名患者术后1年及3年的疗效,采用JOA评分,分析术前与术后1年和3年的对照。结果术后1年和术后3年的平均改善率分别为(84.0±9.0)%和(85.4±8.1)%,疗效对比无明显差异。结论保留棘突韧带复合结构椎管潜行减压,既可对腰椎管狭窄进行减压,又可减少对腰椎稳定性的损害。     

Degenerative lumbar spinal stenosis

The aim of the study was to evaluate the long-term outcome of various surgical procedures for lumbar spinal stenosis. Operations were performed on 117 consecutive patients for lumbar spinal stenosis between 1987 and 1992. Pre- and intraoperative data were recorded in a standardized manner. Three treatment groups were distinguished: group I consisting of 39 patients submitted to undercutting decompression; group II, 51 patients, submitted to laminectomy and foraminal decompression alone; and group III, 27 patients, who underwent foraminal decompression and laminectomy with instrumented fusion. Eight years (5–10 years) after surgery a questionnaire was mailed to the patients containing the outcome scales according to Greenough and Fraser [6] and Turner et al. [22] together with questions about residual pain, necessity of treatment and satisfaction with the operative outcome. A total of 72 questionnaires (61.6%) gave enough information for analysis. After a mean follow-up of 8 years, walking capacity had increased significantly in all groups (P<0.001). Compared to preoperative values, pain had decreased significantly in all groups (P<0.01). In group I 36% had good-to-excellent outcomes, and 30.8% and 23.8% in groups II and III (P>0.05). Forty percent of group I patients were unsatisfied with the result, compared to 38.4% and 33.3% in the other groups (P>0.05). Overall, 25 of 72 patients (34.7%) had severe constant back and/or leg pain requiring daily administration of analgesics. We conclude that the long-term outcome of decompressive surgery of the lumbar spinal canal, without and with instrumented fusion, is less favourable than was previously reported. Received: 26 June 1998 / Accepted: 19 August 1998     

Multilevel lumbar laminotomies: an alternative to laminectomy in the treatment of lumbar stenosis

The traditional treatment for lumbar stenosis is a wide laminectomy. This procedure has a high success rate and a low, but not insignificant, incidence of complications. Recently, however, a better understanding of the pathophysiology of spondylotic lumbar stenosis has led several authors to propose a more limited decompression directed specifically toward the offending area of compression. Over the past 5 years, we have treated 32 patients with lumbar stenosis using decompressive laminotomies. Our patients all had focal lateral recess stenosis that was diagnosed by computed tomography or magnetic resonance imaging. We performed decompressive laminotomies and foraminotomies at appropriate levels. This procedure is less disruptive than a full laminectomy and, in experienced hands, requires less operating time. At last follow-up, 90% of the patients so treated reported an excellent outcome--namely, total relief of symptoms and/or return to normal daily activities. There was no significant postoperative morbidity or mortality. We conclude that in a selected subgroup of patients with lumbar stenosis, multilevel laminotomies may be an acceptable alternative to laminectomy.     

METRx内窥镜辅助X-Tube下治疗腰椎间盘突出症

目的 评价内窥镜下经x-tube腰椎板切除减压,髓核摘除术的初步临床效果。 方法 自2010年1月共收治13例腰椎间盘突出患者,其中L4/5节段7例,L5/S1节段6例,均行内窥镜下经x-tube腰椎板切除减压,髓核摘除术,按改良Macnab评分标准评价临床效果,同时记录手术时间,失血量及并发症。结果 所有病例均得到随访,随访时间3～12个月,平均6个月。术后功能评定按改良Macnab评分分级：优10例,良3例,优良率100%。未发现手术并发症。手术时间45～105min,平均60min,失血量10～95ml,平均30ml。结论 METRx内窥镜辅助X-Tube下治疗腰椎间盘突出症,具有微创直视化、管道化特点,效果满意;应严格把握手术适应症,术中仔细操作,避免手术并发症发生。     

Minimum 10-year outcome of decompressive laminectomy for degenerative lumbar spinal stenosis

STUDY DESIGN: A retrospective follow-up study was conducted in patients who underwent decompressive laminectomy for degenerative lumbar spinal stenosis. OBJECTIVES: To describe the long-term outcome of decompressive laminectomy performed for degenerative lumbar spinal stenosis, and to investigate preoperative factors that influenced outcomes, especially risk factors predisposing patients to poor results. SUMMARY OF BACKGROUND DATA: The success rate of surgical treatment of decompressive laminectomy for lumbar spinal stenosis varies. Long-term follow-up investigations have indicated deterioration of outcome; however, the causes of deterioration have not been fully investigated, and there have been no reports with a minimum 10-year follow-up. METHODS: Of 151 patients who underwent decompressive laminectomy from 1980 through 1989, 37 were followed up for a minimum of 10 years. The mean age at surgery was 60.9 +/- 8. 2 years (range, 43-76), and the average follow-up period was 13.1 +/- 2.1 years (range, 10.1-17.4). The results were evaluated by the criteria of the Japanese Orthopedic Association Lumbar Score, and the outcome was classified as excellent at more than 75% improved score; good, 50-75%; fair, 25-49%; and poor, 0-24% or less. Information about impairment of activities of daily living was also obtained at follow-up. Associations between preoperative clinical and radiographic variables and clinical outcome were evaluated statistically. RESULTS: In all patients, the average score improvement of 55.2 +/- 31.6% was regarded as acceptable. The postoperative score and percentage of improvement of low back pain were lower than those of leg pain and walking ability. No impairment in activities of daily living was found in 62.2% of the patients. Rate of improvement was evaluated as excellent in 13 (35.1%), good in 8 (21.6%), fair in 8, and poor in 8 patients. Three patients required additional surgery because of disc herniation at the laminectomied segments. The patients with multiple laminectomy (P = 0.034) and more than 10 degrees preoperative sagittal rotation angle (P = 0.018) showed a significantly poorer outcome than the remainder of the patients. CONCLUSIONS: Long-term follow-up showed that even without spinal fusion, more than half the patients were evaluated as excellent or good. Patients with more than a 10 degrees sagittalrotation angle who need multiple laminectomy, should be given information about the possibility of earlier deterioration of the outcome, and alternative or additional treatment such as concomitant spinal fusion with decompression may be considered.     

两种脊柱融合术治疗腰椎管狭窄症合并轻度腰椎滑脱的临床疗效比较

目的比较两种脊柱融合术治疗腰椎管狭窄症伴轻度腰椎滑脱的临床疗效。方法将1998年4月至2003年4月收治的45例患者分为A、B两组。分别行椎管减压 SOCON复位 横突间植骨术(A组),在A组基础上加用椎间融合器(Cage)固定(B组)。A组24例,平均54岁,其中退变型17例,峡部型7例。B组21例,平均53岁,其中退变型16例,峡部型5例。两组滑脱主要部位为L4-5和(或)L5～S1,滑脱度为Ⅰ至Ⅱ度,术前均行脊髓造影或CTM检查,证实有侧隐窝狭窄和(或)中央椎管狭窄。结果随访时间1～6年,A组临床疗效满意率91．7％(22／24);完全复位率为91．7％(22／24)。B组临床疗效满意率90．5％(19／21);完全复位率为95．2％(20／21)。A组手术时间、术中出血、输血量、手术并发症情况优于B组,两组滑脱复位率及随访后最终临床疗效无显著差异,B组滑脱角及椎间盘指数恢复优于A组。结论彻底减压、后外侧融合加椎弓根内固定是首选手术方案,应强调Cage适应证。     

Surgical management of lumbar spinal stenosis

Eighty consecutive patients with lumbar spinal stenosis surgically treated during a 5-year period by the author were reviewed. Patients were placed in the following categories: lateral spinal stenosis (10), central-mixed stenosis (29), spinal stenosis after laminectomy and/or fusion (32), and spinal stenosis with degenerative scoliosis (9). Contrast-enhanced computed tomographic (CT) scans were helpful in determining the levels requiring decompression. However, in the multiply operated patient, contrast-enhanced CT scans were misleading in six patients. Patients with lateral spinal stenosis were treated with unilateral laminectomy and partial facetectomy. The 29 patients with central-mixed stenosis underwent decompressive laminectomy and bilateral facetectomies. Six fusions were done. In the nine patients with spinal stenosis and scoliosis, concaveside partial facetectomies and laminectomies were done as well as spinal fusions. The 32 patients with spinal stenosis after previous laminectomy and spinal fusions were the most difficult group to analyze, and their treatment was the least standardized. There were 19 good, eight fair, and five poor results in those who had undergone previous surgery. Fifty-seven of the 80 patients (71%) experienced a good result from their surgical treatment.     

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。     

退行性腰椎管狭窄症采用不同手术方法治疗的临床观察

目的：探讨退行性腰椎管狭窄症的手术方法选择与疗效分析。方法：1996年9月至2007年3月共收治68例退行性腰椎管狭窄症患者,男40例,女28例;年龄32～78岁,平均52.8岁;平均病程51个月。依据Hansraj的经典与复杂型腰椎管狭窄症分型标准及引起症状的＂责任＂部位,经典的腰椎管狭窄症患者采用全椎板切除＋根管扩大（A组18例）或半椎板切除＋根管扩大（B组11例）及椎板间开窗＋根管扩大（C组17例）;复杂型腰椎管狭窄症患者行全椎板切除减压＋椎弓根螺钉内固定＋横突间、椎体间融合（D组22例）。采用日本骨科学会JOA15分法对术前和末次随访时的神经与自觉症状进行评估,计算改善率,并对结果进行统计学分析。结果：68例均获得随访,时间8个月～11年,平均64个月。末次随访时JOA评分改善率：A组（51.2±26.6）%,B组（60.7±21.1）%,C组（59.3±23.1）%,D组（59.1±22.7）%。均好于术前（P〈0.001）。结论：CT和MRI等影像学检查结果与临床症状体征相结合是决定手术减压范围的关键;腰椎稳定与否是决定固定和植骨融合的关键。     

腰椎间盘突出症再手术原因分析和手术方式探讨

目的:探讨腰椎间盘突出症再手术的原因及手术方式。方法:对39例腰椎间盘突出症术后症状无改善或缓解一段时间后复发需再手术的患者进行分析和总结。再手术方式:椎板间开窗或经原椎板间扩大开窗、椎间盘切除8例;半椎板切除减压、椎间盘切除3例;全椎板切除减压、椎间盘切除27例(其中23例行后路椎弓根内固定加横突间植骨融合,2例同时行椎间cage置入融合);经左前外侧入路腹膜外椎间盘切除、椎间植骨融合1例。结果:再手术原因包括复发性腰椎间盘突出20例、相邻节段腰椎间盘突出7例、腰椎节段性不稳定8例和腰椎间盘未彻底去除4例,其中合并继发性腰椎管狭窄8例,硬膜外瘢痕形成4例。术中发生脑脊液漏4例,均行硬膜修补,术后恢复良好。随访1年6个月～5年7个月,其中31例患者症状明显改善,7例症状部分改善,1例无改善,优良率为79.5%。再手术前JOA评分平均11.8分,再手术后末次随访时平均25.6分,有显著性差异(P<0.05),恢复率为80.2%。23例行椎弓根内固定加横突间植骨融合患者末次随访时植骨融合率为70%,1例行椎间植骨融合患者末次随访时植骨融合。结论:腰椎间盘突出症再手术的主要原因为复发性腰椎间盘突出、相邻节段腰椎间盘突出、腰椎节段性不稳定和腰椎间盘未彻底去除等,正确分析再手术原因并选择合理的手术方式,仍可以取得较为满意的疗效。