腰椎管狭窄症术后脑脊液漏1例

患者，女性，56岁，因“腰痛10年，加重伴双下肢麻木、无力两年”于2002年7月3日入院，患者于10年前诱因不明常感腰痛，尤劳累后加重，近两年来除劳累后加重外，同时感双下肢麻木、无力。不能远距离行走，每步行约20分钟即需蹲下休息后方能再走，而骑单车不受影响，经当地对症治疗无效。来我院门诊CT检查诊断为“腰椎管狭窄症”后收住院，入院查     

单侧显露保留棘突腰椎管扩大术治疗腰椎管狭窄症28例分析

本文采用单侧显露保留棘突腰椎管扩大术治疗腰椎管狭窄症28例,经半年至5年随访,优25例,良2例,可1例,优良率为96.4％。作者对此手术的具体方法进行了阐述,以椎管的良好显露,脊柱的后柱稳定,保留棘突及脊柱后部功能等方面讨论本手术的优点。     

糖尿病对腰椎管狭窄症患者术后康复效果的影响：1：1配对分析

目的：探讨腰椎管狭窄症合并糖尿病患者术后康复效果的特点。 方法：选择1992-01／1999-07在重庆市涪陵中心医院骨科接受腰椎管减压术的患者56例，均自愿参加观察。分为2组，糖尿病组和非糖尿病组各28例。对两组患者的临床特点进行1：1回顾性配对分析。患者在康复后1～6个月开始检查，随访时间2-5年，对术后康复效果进行评估。临床效果评估为优、良、可、差。优为腿痛完全消失，正常活动完全恢复。良为偶而出现腿痛，不需药物可缓解，可以正常活动。可为中等度疼痛，常需药物才能缓解，正常活动轻度受限。差为术前症状改善不明显或无改善，或正常活动严重受限。客观评估标准为神经传导速度检测记录。 结果：56例患者全部进入结果分析，无脱落。①两组患者临床特点比较：除糖尿病组患者有突然发作、夜间痛、疼痛非体位性缓解等特点外，两组的其他术前症状相似。周围血管供血不足在糖尿病组占29％、非糖尿病组占4％。②两组患者电生理检查结果比较：糖尿病组78％的患者及非糖尿病组25％的患者出现神经传导速度减慢。③两组患者术后康复效果比较：糖尿病组28例患者术后康复效果优、良、可、差分别为5，15，5，3例；非糖尿病组分别为6，16，5，1例，两组相比差异无显著性意义（x^2=0．56，P〉0．05）。 结论：神经传导检查是腰椎管狭窄症合并糖尿病最有价值的客观评估手段，糖尿病不影响腰椎管狭窄症患者的术后康复。     

1例腰椎管狭窄症术后合并睡眠呼吸暂停综合征患者的护理

患者，女性，77岁，于2005年4月时无明显诱因出现双下肢及足部持续性隐痛伴麻木来我院就诊，予腰部CT提示：L4、5，椎管狭窄，经卧床休息、理疗、局部封闭等治疗措施后症状无明显改善且逐渐加重，于2005年6月13日再次就诊，以“腰椎管狭窄症”手术治疗收住入院。入院查体：体温36．7℃，脉搏96次／min，呼吸17次／min，血压140／80mmHg，体重76kg。患者神志清楚，精神一般，呼吸平稳，心律规则。脊柱无畸形，棘突无压痛，双下肢触痛（＋），以足背触痛更甚。双下肢膝部以下皮肤感觉减退，以左侧为甚。     

腰椎管狭窄症术后下床时间的研究

目的探讨老年人腰椎管狭窄症术后病人下床时间。方法将90例病人按单盲法,随机分为A、B、C三组,各30例。每组规定不同的下床时间,A组为术后6～10d下床,B组为术后11～15d下床,C组为术后16～20d下床,观察下床活动时间与再次出现腰腿痛的关系。并进行评分和统计学处理。结果A组30例病人中有9例发生腰痛,腿痛2例,腰腿痛4例,疼痛评分45分。B组病人中出现再次腰痛5例,腿痛1例,腰腿痛2例,疼痛评分16分。C组出现腰痛3例,疼痛评分7分。经T检验比较,A、B两组比较p0.05,A、C两组比较p0.05,B、C两组无显著性差异。结论通过本研究得出,对于老年性腰椎管狭窄症手术后的病人,在没有严重并发症的情况下,手术11d后下床活动再发生腰腿痛的机率明显降低,且疼痛程度较轻,更符合自然愈合规律。     

腰椎管狭窄症的探讨

从广义上讲凡引起腰椎容积减小均称椎管狭窄综合症。腰椎管狭窄症是指腰椎骨腔内某些原因发生骨性或纤维性结构异常，导致一个平面或多个平面的一处或多处骨腔变窄。     

腰椎管狭窄症10例围术期护理

对10例腰椎管狭窄症患者行腰椎管环形减压术,并给予精心围术期护理.结果10例患者均进行随访,平均6个月;8例随访疗效达优,2例良好.认为良好的围术期护理是保证腰椎管狭窄症患者手术成功的关键,可促进患者早日康复.     

腰椎管狭窄症10例围术期护理

对10例腰椎管狭窄症患者行腰椎管环形减压术,并给予精心围术期护理。结果10例患者均进行随访,平均6个月;8例随访疗效达优,2例良好。认为良好的围术期护理是保证腰椎管狭窄症患者手术成功的关键,可促进患者早日康复。     

腰椎滑脱合并腰椎管狭窄手术疗效分析

目的探讨不同手术方法治疗腰椎滑脱合并腰椎管狭窄的临床效果。方法将2011年1月²014年1月间我院收治的68例腰椎滑脱合并腰椎管狭窄的患者随机分为对照组和观察组两组,对照组患者采用单纯有限减压术进行治疗,观察组患者采用椎管减压联合椎弓根内固定和植骨融合术进行治疗,比较两组不同手术方法治疗的效果。结果观察组患者的腰椎JOA评分优良率明显高于对照组,并且治疗后的Prolo评分以及VAS评分均明显优于对照组,两组间差异均具统计学意义(P<0.05)。结论椎管减压联合椎弓根内固定和植骨融合术治疗腰椎滑脱合并腰椎管狭窄,在固定牢固和腰椎功能恢复方面效果显著,是治疗腰椎滑脱合并腰椎管狭窄的可靠选择。     

Lumbar Spinal Stenosis: A Literature Review

Abstract

This paper describes the etiology and clinical manifestations of lumbar spinal stenosis (LSS); discusses diagnosis, prognosis, and intervention; and addresses outcome studies and their implications in managing patients with lumbar spinal stenosis. LSS is a condition involving narrowing of the central spinal canal, lateral recesses, or intervertebral foramina; it is the most commonly diagnosed degenerative process associated with aging. Neurogenic intermittent claudication is a common clinical manifestation of LSS that must be differentiated from vascular claudication of the lower extremities. Although surgery is commonly performed in treating LSS, some evidence exists to support the use of a conservative approach such as orthopaedic manual physical therapy. However, controlled clinical trials with large sample sizes are lacking to offer strong support for either conservative or surgical measures. This paper provides a rationale for a manual physical therapy and exercise approach in treating LSS. Future studies need to include comparative research involving different conservative approaches, and indications for surgical versus nonsurgical management of LSS need to be more clearly defined and studied through randomized, controlled clinical trials.     

Long‐Term Results of Percutaneous Lumbar Decompression mild® for Spinal Stenosis

Background: Lumbar spinal stenosis (LSS) generally occurs from a combination of degenerative changes occurring in the lumbar spine. These include hypertrophy of ligamentum flavum, facet joint arthritic changes and bulging of the intervertebral disk. Spinal stenosis leads to compression of the lumbar neural elements (cauda equina), which manifests as low back and leg pain especially on standing and walking known as “neurogenic claudication.” Current treatment options for LSS are varied. Conservative management, including physical therapy with/without epidural steroid injections, may be adequate for mild stenosis. Surgical decompression is reserved for severe cases and results in variable degrees of success. Patients with moderate‐to‐severe LSS having ligamentum flavum hypertrophy as a key contributor are generally inappropriately treated or undertreated. This is due to ineffectiveness of conservative therapy and possibility that major surgical compression might be too aggressive. Percutaneous decompression offers a possible solution for this patient population. Methods: One‐year follow‐up study was conducted at 11 U.S. sites. Study cohort included 58 mild^® percutaneous decompression patients who underwent 170 procedures, the majority treated bilaterally at one or two lumbar levels. Outcome measures included the visual analog scale (VAS), Oswestry Disability Index (ODI), Zurich Claudication Questionnaire (ZCQ), and SF‐12v2^® Health Survey. Results: No major mild^® device or procedure‐related complications were reported. One‐year data showed significant reduction of pain as measured by VAS. Improvement in physical functionality, mobility, and disability was significant as measured by ZCQ, SF‐12v2, and ODI. Conclusions: At 1 year this 58‐patient cohort demonstrated continued excellent safety profile of the mild^® procedure and equally important, showed long‐term pain relief and improved functionality.     

Functional and Patient‐Reported Outcomes in Symptomatic Lumbar Spinal Stenosis Following Percutaneous Decompression

Background: Neurogenic claudication due to symptomatic lumbar spinal stenosis (LSS) is a painful condition causing significant functional disability. While the cause of LSS is multifactorial, thickened ligamentum flavum (LF) accounts for up to 85% of spinal canal narrowing. mild percutaneous lumbar decompression allows debulking of the hypertrophic LF while avoiding the morbidities frequently associated with more invasive surgical procedures. Methods: In this prospective case series study, consecutive LSS patients presenting with neurogenic claudication were treated with percutaneous lumbar decompression. Efficacy was evaluated using the Pain Disability Index (PDI) and Roland‐Morris Disability Questionnaire. Pre‐ and postprocedure Standing Time, Walking Distance, and Visual Analog Score (VAS) were also monitored. Significant device‐ or procedure‐related adverse events were reported. Results: The mild procedure was successfully performed on forty patients. At twelve months, both PDI and Roland‐Morris showed significant improvement of 22.6 points (ANOVA, P < 0.0001) and 7.7 points (ANOVA, P < 0.0001), respectively. Walking Distance, Standing Time, and VAS improvements were also statistically significant, increasing from 246 to 3,956 feet (ANOVA, P < 0.0001), 8 to 56 minutes (ANOVA, P < 0.0001), and 7.1 to 3.6 points (ANOVA, P < 0.0001), respectively. Tukey HSD test found improvement in all 5‐outcome measures to be significant from baseline at each follow‐up interval. No significant device‐ or procedure‐related adverse events were reported. Conclusion: This study demonstrated significant functional improvement as well as decreased disability secondary to neurogenic claudication after mild procedure. Safety, cost‐effectiveness, and quality‐of‐life outcomes are best compared with comprehensive medical management in a randomized controlled fashion and, where ethical, to open lumbar decompression surgery.     

缩小切口扩大开窗术治疗腰椎间盘突出并椎管狭窄症

根据腰椎间盘突出及椎管狭窄的部位采取单侧单(或双)间隙、双侧单(或双)间隙或双侧双间隙多处扩大开窗术。结果本院手术60例,随访6-48(平均21.6)个月,优良率达93.3%。     

腰椎管狭窄症的运动处方：附9例报告

为了评价腹肌锻炼对腰椎管狭窄症的疗效，我们选了９例患者。并对治疗前后静态和动态肌力，椎管矢状径等进行了比较。结果显示：疗效优３例，良５例，差１例。治疗后腹肌肌力增强。治疗前、后椎管矢状径分别为（８．７２±０．４４）ｍｍ和（１０．７８±０．４４）ｍｍ，有显著性差异（Ｐ＜０．００１）。所以，我们认为腹肌锻炼是腰椎管狭窄症的一种有效治疗方法。     

Management of Lumbar Spinal Stenosis through the Use of Translatoric Manipulation and Lumbar Flexion Exercises: A Case Series

Abstract

Lumbar spinal stenosis is a narrowing of the spinal canal or intervertebral foramen that can produce low back pain and leg pain and weakness. Surgical intervention is commonly performed to relieve these symptoms. Symptom reduction and longitudinal management of functional deficits with conservative care is less well documented. The purpose of this case series was to describe the outcomes of a conservative physical therapy program consisting of low- and high-velocity translatoric manipulations of T1-T9 and L1-L3, and two lumbar flexion exercises on 6 subjects diagnosed with lumbar spinal stenosis and neurogenic claudication. A treadmill test was repeated on a weekly basis and at discharge for each patient. All six subjects demonstrated improvements in treadmill walking time prior to the onset of neurogenic claudication (range: 1 min 34 sec to 26 min); in Oswestry Low Back Pain Disability Index scores (range: 7.5% to 64.7%); and in McGill Pain Questionnaire scores (range: 25% to 57%). Five subjects were measured using the Schober technique, and all showed improvement in thoracolumbar flexion mobility. Combined use of translatoric manipulation and spinal flexion exercises may have resulted in improved spinal flexibility, ambulatory abilities, and pain and functional status in six subjects with lumbar spinal stenosis.     

腰椎管狭窄症并腰椎不稳的手术治疗

目的:探讨腰椎管狭窄症合并腰椎不稳的诊断和治疗。方法:52例腰椎管狭窄症合并腰椎不稳,男31例,女21例,平均年龄58.7岁,采用双侧半椎板有限元减压保留棘突韧带同时加椎弓根螺钉内固定植骨术治疗。结果:随访1.5～4.5年,平均2年7个月,植骨全部愈合,内固定位置正常,但有4例延迟愈合。术前JOA评分平均3.2分,术后平均13.8分,平均改善率89.83%,优良率94.23%。结论:在充分减压的同时保留棘突韧带,提供椎弓根螺钉内固定并植骨,能保持脊柱的稳定性,临床应用疗效肯定。     

腰椎管狭窄症穹顶形减压术后早期下床活动对其疗效的影响

目的研究腰椎管狭窄症行穹顶形开窗减压术后2种不同时间下床活动对其疗效的影响,客观地获得下床活动的最佳时间。方法将80例采用穹顶形开窗减压术的腰椎管狭窄症患者随机分为实验组和对照组,各40例。实验组于术后第72 h、对照组于术后第10 d开始在腰围保护下下床活动,于术前、术后半年、术后一年对患者采用改良的日本骨科学会下腰痛评分法(简称M-JOA)进行评分,对两组的改善率进行比较。结果术后半年和术后一年,实验组与对照组的改善率差异均无统计学意义(P>0.01)。结论早期下床活动和晚期下床活动对近期疗效的影响均无差异,但早期下床活动可预防许多术后并发症,因此,应鼓励患者早期下床活动。