腰神经根管狭窄症34例

腰神经根管狭窄症３４例李松强，应逸飞１９８０年至１９９２年间手术治疗腰椎间盘突出症１０３例，其中有１０例伴有侧隐窝狭窄；腰椎管狭窄症６６例，其中有８例伴有侧隐窝狭窄，盘黄间隙狭窄８例；３例黄韧带肥厚在椎间孔处压迫神经根；有５例为单纯侧隐窝狭窄，均行神...     

退行性腰椎管狭窄症的再认识（附50例分析报告）

目的 :通过 5 0例的分析 ,明确腰椎管狭窄的症状是由中央椎管狭窄还是由侧隐窝狭窄引起的 ,为临床有限手术提供依据。方法 :对 5 0例腰椎管狭窄症患者的临床症状、影像学检查及手术结果进行分析。结果 :针对引起症状的狭窄部位进行有限手术 ,5 0例患者中手术治疗的优良率为 90 %。结论 :诊断腰椎管狭窄症 ,应该明确症状是由中央椎管狭窄引起的还是由侧隐窝狭窄引起的。退行性腰椎管狭窄症 ,绝大多数是侧隐窝狭窄 ,以双侧椎板开窗入路最为适宜。     

手术治疗腰椎管侧隐窝狭窄症37例报告

手术治疗腰椎管侧隐窝狭窄症３７例报告李文平，靳方运，孙晓林，郭斌，张清江，陈成礼，张明我院自１９８９年至１９９４年共收治腰椎管侧隐窝狭窄症患者３７例，均行选择性椎管侧隐窝扩大减压手术。其中男２３例，女１４例；病程１个月～１８０个月，平均１５个月。单纯...     

选择性椎管减压术治疗退行性腰椎管狭窄症

采用选择性椎管减压治疗行性腰椎管狭窄症６８例，经术后平均２７个月的随访、优良率９４．１％。文中将退行性腰椎管狭窄症分为中央性腰椎管狭窄，侧隐窝狭窄，混合性狭窄。分别采用中央开窗、潜行扩大减压、一侧或双侧扩大开窗、侧隐窝扩大，蝶形扩大减压术。文中还对选择性腰椎管减压术的理论依据及减压范围进行了讨论。     

腰椎管侧隐窝狭窄症的外科治疗（附303例临床分析）

我院从１９８５年１月～１９９４年１０月，外科治疗腰椎管侧隐窝狭窄症３０３例，其中男１９３例，女１１０例，年龄２３～３６岁，平均４４．２岁。根据不同的病理特点，分别采用开窗式、半椎板、全椎板切除等方法，摘除椎间盘髓核，切除肥厚黄韧带，关节突和椎体后缘骨赘，扩大狭窄侧隐窝，神经根得到充分减压。手术证实腰椎管侧隐窝狭窄合并腰椎间盘突出２７５例，单纯侧隐窝狭窄２８例，所有病例经１～１０年随访，平均为５年。结果优２７９例，良１１例，进步１２例，差１例，优良率９６％。     

腰椎管狭窄症的针对性减压治疗

目的 :探讨腰椎管狭窄的手术治疗方法。方法 :根据腰椎管狭窄的因素、形式、范围和程度的不同采取不同的减压术式 :全椎板切除治疗单纯中央管狭窄 8例 ;全椎板切除 小关节部分切除治疗严重的退变性中央管狭窄伴侧隐窝狭窄 12例 ;椎板间隙潜行扩大减压治疗椎板间水平的中央管狭窄伴侧隐窝狭窄 17例 ;半椎板切除 小关节部分切除治疗中央管一侧狭窄伴侧隐窝狭窄 13例 ;椎板间开窗减压治疗单纯侧隐窝狭窄 46例。同时行间盘突出髓核摘除 63例 ,腰椎不稳侧后方植骨融合 9例 (内固定 6例 )。结果 :本组 96例 ,平均随访 2年 8个月。疗效评定优良率 82 3 %。术后继发腰椎不稳 6例 (其中全椎板切除组 2例 ) ,发生率 6 2 5 %。再狭窄 4例 ,发生率 4 17%。腰椎融合失败 1例。结论 :针对性减压治疗腰椎管狭窄症手术疗效满意 ,并可减少继发性腰椎不稳和再狭窄发生率     

CT对腰椎管狭窄的诊断及其对手术入路选择的作用研究

目的研究分析CT对腰椎管狭窄分型的诊断价值及其对手术入路选择的指导作用。方法选取2017年1月至2019年1月本院收治的腰椎管狭窄患者共120例,入院后行影像学检查,确定腰椎管狭窄位置。本研究以中央型狭窄或侧隐窝型狭窄并采用椎板间手术入路为例。120例患者在入院后均行CT检查,扫描后测量椎间盘中央切面、椎弓根上切迹切面,CT检查扫描图像由2名影像科副高级医师及骨科主任医师共同审阅并诊断。结果 CT检查及手术观察中,混合型椎管狭窄发生率最高,其次为中央型椎管狭窄。以手术确定椎管狭窄类型为标准,评估CT检查结果发现,有10例患者CT检查结果与手术确定类型不符,CT检查腰椎管狭窄诊断率为91.67%(110/120)。本研究120结论术前CT检查可以有效准确的判断腰椎管狭窄类型,诊断符合率较高,对于不同类型手术方法也有所差异,因此CT检查诊断对腰椎管狭窄的手术方法选择具有一定的指导价值。     

腰椎管狭窄症的影像学诊断

目的：探讨腰椎管狭窄症的X线、CT及MRI诊断价值。方法：分析130例临床诊断和影像学检查征象典型的腰椎管狭窄症的病例资料。男83例,女47例;年龄27～75岁,平均43.5岁。所有病例均行CT检查,其中23例行X线检查,57例行MRI扫描。结果：腰椎管狭窄位于L3,4水平25例,L4,5水平48例,L5S1水平57例。CT显示椎体后缘、椎板、下关节突骨质增生46例,椎板上下关节突肥大7例,黄韧带钙化、骨化13例,椎体向前滑脱5例,侧隐窝狭窄24例,椎间孔狭窄35例。MRI显示椎间盘突出伴黄韧带肥厚23例,黄韧带对称性肥厚18例,广泛多节段增生肥厚9例,局限性黄韧带肥厚7例。结论：继发性腰椎管狭窄症的最常见原因是退变。传统X线检查有很大的局限性,CT和MRI具有多方位成像和分辨率高的优点,但在韧带骨化上MRI难于显示,而CT能很好的显示韧带钙化与骨化及骨质改变,腰椎管狭窄症检查应该首选CT。     

腰椎管侧隐窝狭窄症31例分析

腰椎管侧隐窝狭窄症３１例分析江振华，刘仁寿，章道熙腰椎管侧隐窝狭窄症是腰腿痛常见原因之一。早在１８０２年，Ｐｏｒｔａｌ就注意到脊柱弯曲异常及椎体后凸可压迫椎管内结构。１９５５年，Ｓｃｈｌｅｃｉｎｇｅｒ首次提出骨性侧隐窝狭窄的概念。此后，人们逐渐认识到...     

有限性椎板切除术治疗退行性腰椎管狭窄症

采用有限性椎板切除术治疗退行性腰椎管狭窄症６８例，经术后平均２７个月的随访，优良率９４．１％。文中将退行性腰椎管狭窄症分为中央性腰椎管狭窄，侧隐窝狭窄，混合性狭窄。分别采用中央开窗、潜行扩大减压，一侧或双侧扩大开窗、侧隐窝扩大，蝶形扩大减压术。作者还对有限性椎板切除术的理论依据及减压范围进行了讨论。     

临床论腰椎管狭窄症狭窄因素分类及临床应用

目的:探讨腰椎管狭窄症CT影像学分类方法,为手术减压部位及术式选择提供依据。方法:把腰椎管管壁致狭窄病变的组织分为关节突(A)、椎体与椎弓骨性组织(B)、钙化结缔组织(C)、椎间盘(D)、硬膜外瘢痕(E)和黄韧带(F)六个类别,把椎管分为前壁(1)、侧壁(2)、后壁(3)三个区。通过对43例共70个节段腰椎管狭窄症的CT影像学病因诊断,用字母-数字化代码对椎管管壁狭窄因素进行分类,根据不同狭窄因素行个体化治疗。结果:共统计出12类椎管管壁狭窄因素。43例中40例得到定期随访,随访1~5年,优良率90.0%。结论:腰椎管狭窄症管壁狭窄因素分类方法可表达椎管狭窄的性质、部位,有助于术前减压目标的确定、术式选择和电脑信息化处理。     

Degenerative lumbar spinal stenosis: correlation with Oswestry Disability Index and MR Imaging

Because neither the degree of constriction of the spinal canal considered to be symptomatic for lumbar spinal stenosis nor the relationship between the clinical appearance and the degree of a radiologically verified constriction is clear, a correlation of patient’s disability level and radiographic constriction of the lumbar spinal canal is of interest. The aim of this study was to establish a relationship between the degree of radiologically established anatomical stenosis and the severity of self-assessed Oswestry Disability Index in patients undergoing surgery for degenerative lumbar spinal stenosis. Sixty-three consecutive patients with degenerative lumbar spinal stenosis who were scheduled for elective surgery were enrolled in the study. All patients underwent preoperative magnetic resonance imaging and completed a self-assessment Oswestry Disability Index questionnaire. Quantitative image evaluation for lumbar spinal stenosis included the dural sac cross-sectional area, and qualitative evaluation of the lateral recess and foraminal stenosis were also performed. Every patient subsequently answered the national translation of the Oswestry Disability Index questionnaire and the percentage disability was calculated. Statistical analysis of the data was performed to seek a relationship between radiological stenosis and percentage disability recorded by the Oswestry Disability Index. Upon radiological assessment, 27 of the 63 patients evaluated had severe and 33 patients had moderate central dural sac stenosis; 11 had grade 3 and 27 had grade 2 nerve root compromise in the lateral recess; 22 had grade 3 and 37 had grade 2 foraminal stenosis. On the basis of the percentage disability score, of the 63 patients, 10 patients demonstrated mild disability, 13 patients moderate disability, 25 patients severe disability, 12 patients were crippled and three patients were bedridden. Radiologically, eight patients with severe central stenosis and nine patients with moderate lateral stenosis demonstrated only minimal disability on percentage Oswestry Disability Index scores. Statistical evaluation of central and lateral radiological stenosis versus Oswestry Disability Index percentage scores showed no significant correlation. In conclusion, lumbar spinal stenosis remains a clinico-radiological syndrome, and both the clinical picture and the magnetic resonance imaging findings are important when evaluating and discussing surgery with patients having this diagnosis. MR imaging has to be used to determine the levels to be decompressed.     

腰椎间盘突出并发神经根管狭窄症的诊断与手术治疗（附152例临床分析）

在ＣＴ广泛应用于脊柱疾患诊断以前，腰椎间盘突出并发神经根管狭窄症（ＬＤＨＬＲＳ）易被误诊为单纯腰椎间盘突出症，手术效果不令人满意。对１９８５～１９９１年收治的ＬＤＨＬＲＳ１５２例，充分利用ＣＴ检查，根据不同狭窄情况采用不同手术方法。术后随访１年３个月～６年８个月，优良率为９０．２％。作者提出：（１）应对ＬＤＨＬＲＳ做出定性和定量诊断；（２）根据引起神经管根管狭窄的不同因素，将狭窄分为硬性狭窄、软性狭窄及混合性狭窄，并依此决定手术方式。     

Coflex系统治疗退行性腰椎管狭窄症

 目的 探讨Coflex系统治疗退行性腰椎管狭窄症的初步临床疗效。
方法 2008年3月至2009年8,采用腰椎后路椎管减压棘突间植入Coflex系统治疗退行性腰椎管狭窄症患者26例,男11例,女15例;年龄45～78岁,平均65.4岁。L_3,4节段7例,L_4,5节段13例,L_3,4合并L_4,5节段6例。术前MRI和CT扫描证实L_3,4和（或）L_4,5节段黄韧带增厚,关节突关节骨质增生,合并椎间盘突出致中央椎管及侧隐窝狭窄,神经根或马尾受压。应用eFilm及CAD软件测量术前及术后3个月、12个月手术节段椎间隙前缘高度、后缘高度、活动度,术前、术后椎管面积;采用日本骨科学会评分标准（Japanese Orthopaedic Association,JOA）进行功能评估。
结果 全部病例随访12～24个月,平均15个月。术后患者腰腿疼痛症状均明显缓解,日常生活能力改善。JOA评分由术前平均（15.46±4.30）分改善至术后3个月（24.50±1.58）分,责任节段椎管面积由术前平均（218.4±16.2）mm 2增加至术后（264.6±9.9）mm 2。单节段椎间隙前缘高度无明显变化,椎间隙后缘高度较术前增加,随时间延长高度有所下降。术后手术节段仍保留一定的活动度,但较术前明显下降。Coflex系统无松动、断裂及脱出。
结论 Coflex系统治疗退行性腰椎管狭窄症可较好地维持相应节段的稳定性,安全可行,近期疗效满意。     

腰椎神经根冠状位、矢状位和轴位MR扫描定位诊断腰椎椎间孔狭窄症

 目的 探讨腰椎神经根冠状位、矢状位和轴位 MR 扫描定位诊断腰椎椎间孔狭窄症的可行性和有效性。方法回顾性分析 2006 年 6 月至 2011 年 6 月共 21 例腰椎椎间孔狭窄患者的相关资料,男 10 例,女 11 例;年龄 36~65 岁, 平均 45.6 岁。病史 6~36 个月,平均 9.4 个月。5 例表现为腰痛伴单侧下肢痛,16 例为单侧下肢痛。根据腰椎侧位 X 线片测量椎间隙和椎间孔高度并行腰椎神经根冠状位、矢状位和轴位 MR 扫描检查,了解神经根周围组织结构的改变,定位诊断神经根受压部位;并通过手术证实影像学诊断的准确性。结果 21 例患者中 9 例为椎间盘突出导致椎间孔狭窄,12 例为椎间盘弥漫性膨出合并关节突关节增生、肥大导致椎间孔狭窄;21 例均为下腰椎椎间孔横向狭窄,20 例为 L4,5 椎间孔狭窄,造成 L4 神经根受压;1 例为 L5S1 椎间孔狭窄,造成 L5 神经根受压。经手术探查证实与术前定位诊断完全符合,符合率为 100%（21/21）。术后 20 例患者下肢疼痛症状完全缓解,1 例下肢疼痛症状缓解不满意。结论 腰椎神经根冠状位、矢状位和轴位 MRI 扫描方法能准确定位诊断椎间孔狭窄,为确定手术方案提供了准确的影像学依据。     

临床论著多节段经椎板间隙椎管扩大术治疗腰椎管狭窄症

目的:探讨多节段经椎板间隙椎管扩大术治疗腰椎管狭窄症的疗效。方法:采用潜式扩大中央椎管和神经根管或摘除椎间盘术式治疗腰椎管狭窄症共86例。其中2节段减压57例,3节段减压19例,4节段减压10例。术后进行Oswestry疗效评分与影像学观察。结果:术后CT显示椎管直径明显增加,椎管造影显示神经根管明显扩大。术后1年随访79例,疗效优良率90.1%;术后3年随访76例,优良率86.3%。结论:多节段经椎板间隙椎管扩大术操作简单,手术并发症少,中央椎管和神经根管减压充分,对腰椎后柱张力带结构破坏小,治疗腰椎管狭窄症疗效满意。     

A comprehensive study of patients with surgically treated lumbar spinal stenosis with neurogenic claudication

BACKGROUND: The relationship between objective measurements and subjective symptoms of patients with spinal stenosis and the degree of narrowing of the spinal canal is not clear. The purpose of this study was to evaluate patients undergoing surgery for lumbar spinal stenosis and intermittent neurogenic claudication with functional testing, quantitative imaging, and patient self-assessment. METHODS: Sixty-two patients with lumbar spinal stenosis and neurogenic claudication were prospectively enrolled in the study. All underwent preoperative magnetic resonance imaging and/or computed tomography myelography, and all were treated with decompressive surgery and were followed for a minimum of two years. The evaluation included treadmill and bicycle exercise tests as well as patient self-assessment with use of the Oswestry Disability Index and a visual analog pain scale preoperatively and postoperatively. RESULTS: Preoperatively fifty-eight (94%) of the patients had a positive result (provocation of symptoms) on the treadmill test and twenty-seven (44%) had a positive result on the bicycle test, whereas postoperatively six and twelve, respectively, had positive results. The mean preoperative scores on the Oswestry Disability Index and visual analog pain scale were 58.4 and 7.1, respectively. Postoperatively, these scores decreased to 21.1 and 2.3, respectively, and both decreases were significant (p < 0.05). Forty-seven (76%) of the patients were seen to have central stenosis on the preoperative imaging studies; forty-one of them had a cross-sectional area of the dural tube of <100 mm (2) at at least one level and twelve had a cross-sectional area of <100 mm (2) at at least two levels. CONCLUSIONS: A positive treadmill test was consistent with a diagnosis of spinal stenosis and neurogenic claudication in >90% of the patients preoperatively. Following surgical decompression of the lumbar spinal stenosis, more functional improvement was demonstrated by the treadmill test than by the bicycle test. The scores on the Oswestry Disability Index and visual analog pain scale also improved postoperatively. The severity of central canal narrowing at a single level does not appear to limit the postoperative improvement in either functional ability or patient self-assessment. Patients with multilevel central stenosis were, on the average, older and walked a shorter distance preoperatively and postoperatively, although the improvement in their postoperative self-assessment scores was similar to that of patients with single-level stenosis.     

A study of computer-assisted tomography. II. Comparison of metrizamide myelography and computed tomography in the diagnosis of herniated lumbar disc and spinal stenosis

One hundred twenty-two patients with surgically confirmed pathology consisting of either herniated lumbar disc, spinal stenosis, or both were included in this investigation. For each of these patients, preoperative metrizamide myelography and computerized tomography were performed. Each myelogram and CT scan was read blindly so that the neuroradiologist interpreting the study had no knowledge of the patient's surgical pathology, clinical examination, nor any knowledge of the interpretation of the other preoperative test. A painstaking attempt was made to describe precisely both the exact nature of the preoperative myelogram and CT scan interpretations. The correlations between the preoperative interpretation of each test and the observed surgical findings then were analyzed statistically. Based upon this analysis, myelography was found to be more accurate than computed tomography in the diagnosis of herniated lumbar disc (83% vs. 72%). In the diagnosis of spinal stenosis, myelography was slightly more accurate than computed tomography (93% vs. 89%). Based upon the results of this study, the authors conclude that metrizamide myelography is more accurate than computed tomography in the diagnosis of both herniated lumbar disc and spinal stenosis and remains the diagnostic study of choice for these conditions. Furthermore, metrizamide myelography gives the added advantage of visualizing the thoracolumbar junction and, thus, affords the opportunity to diagnose occult spinal tumors.