单纯椎管减压治疗腰椎管狭窄症疗效分析

目的：分析单纯椎管减压治疗腰椎管狭窄症的手术疗效。方法：回顾性分析2005年1月-2008年12月间我科收治的腰椎管狭窄症随访患者26例,男17例,女9例,年龄45-74岁。单侧开窗减压8例,双侧开窗减压11例,单侧半椎板切除减压3例,双侧半椎板切除减压4例,同时行神经根通道扩大21例,26例均行相应椎间盘髓核切除。结果：26例患者经过27-70月随访,术后腰腿疼痛不能完全缓解4例,术后12月时存在慢性腰痛6例。术后24月时慢性腰痛或合并下肢麻木疼痛需要治疗者7例,其中单侧开窗减压术后1例,双侧开窗减压术后2例,单侧半椎板切除减压术后1例,双侧半椎板切除减压术后3例。接受再手术3例,其中单侧半椎板切除减压术后1例,双侧半椎板切除减压术后2例。结论：单纯椎管减压治疗腰椎管狭窄症是有效方法之一,但应严格掌握其适应症。减压不彻底、术后腰椎不稳是其术后慢性腰腿痛的主要原因。

Effect analysis of treating patients with lumbar spinal stenosis by limited vertebral canal decompression

Objective：To assess efficacy of limited vertebral canal decompression in patients with lumbar spinal stenosis.Methods：From January 2005 to December 2008 in orthopedics department, 26 patients with lumbar spinal stenosis consisted of 17 males and 9 females,ranging from 45 to 74 years of age,were retrospectly analyzed. Among them,unilateral fenestration decompression was performed in 8 cases, bilateral fenestration decompression was performed in 11 cases, unilateral laminectomy was performed in 3 cases and bilateral laminectomy was performed in 4 cases. Moreover,nerve roots canal were expanded in 21 cases and corresponding intervertebral disc excision in all. Results：Following-up 27 to 77 months after the operation,waist and leg pain were not relieved in 4 cases and chronic low back pain patients were defined for 12 months after operation.There were 7 patients with leg pain and numbness of lower limbs for 24 months after operation who need to be treated, including 1 case of unilateral fenestration decompression,2 cases of bilateral fenestration decompression,1 case of unilateral laminectomy and 3 cases of bilateral laminectomy. There were 3 patients who need to be received reoperation,including 1 case of unilateral fenestration decompression and 2 cases of bilateral fenestration decompression. Conclusion： This study suggests that the method of treaing patients with lumbar spinal stenosis by limited vertebral canal decompression can provide a beneficial effect,but indications should be strictly regulated.The main reasons for chronic low back pain after operation may be incomplete decompression and lumbar instability after operation.