退变性腰椎管狭窄症的手术治疗

目的探讨退变性腰椎管狭窄症（degenerative lumbar spinal stenosis,DLSS）手术治疗方法。方法回顾性分析2003年1月至2011年1月我院185例退变性腰椎管狭窄症手术治疗病例。其中神经根管狭窄6例,中央管狭窄179例。单节段狭窄者96例,双节段狭窄者55例,3个节段狭窄者34例。采用单纯开窗减压者6例,后路全椎板切除减压、后外侧植骨融合、内固定70例,后路全椎板切除减压、椎体间植骨融合、内固定109例。根据日本矫形外科学会腰腿痛评分系统（15分）进行术前和术后的疗效评价。结果 185例患者获得8～72个月随访,平均随访时间19.5个月。三种手术方法术后平均改善率分别为77.9%、78.8%和79.5%,优45例,良120例,可20例,优良率为89.2%。术后并发脑脊液漏6例。结论根据DLSS患者病情和影像学检查结果,确定狭窄的部位和节段,对神经根管狭窄者,采用单纯开窗减压;对中央管狭窄者,采用全椎板切除减压、椎体间植骨融合和/或后外侧植骨融合、椎弓根系统内固定,尤其是对于合并腰椎节段性不稳定、退变性滑脱、侧弯和后凸者,可获得满意的疗效。

Surgical Treatment of Degenerative Lumbar Spinal Stenosis

Objective To discuss surgical approaches of degenerative lumbar spinal stenosis(DLSS).Methods This study retrospectively examined 185 patients with DLSS from January 2003 to January 2011,who were treated operatively.Six of the patients had nerve root canal stenosis and others had central canal stenosis.The patients included 96 cases with single stenosis segment,55 cases with double stenosis segments and 34 cases with triple stenosis segments.Six patients underwent simple decompression,70 patients underwent decompressive laminectomy,posterolateral lumbar fusion and fixation,109 underwent decompressive laminectomy,posterior lumbar interbody fusion and fixation.According to criteria of Japan Orthopedic Association(JOA) score,the outcome of the preoperation and postoperation were evaluated.Results 185 cases were followed up for 8~72 months,The average follow up period was 19 months.The mean postoperative improvement rate was 77.9%,78.8%and 79.5%.There were excellent in 45 cases,good in 120 cases,fair in 20 cases.And the excellent and good rate was 89.2%.There were six patients with leakage of cerebrospinal fluid.Conclusion According to patients′clinic symptom and radiology evaluatin,the location,extent and segment of DLSS were evauated.The patients with nerve root canal stenosis shall be treated with simple decompression.The patients with central canal stenosis shall be treated with decompressive laminectomy,posterolateral lumbar fusion and/or posterior lumbar interbody fusion and fixation,especially DLSS with lumbar spinal instability,degenerative lumbar spondylolisthesis and degenerative scoliolosis.