个体化手术治疗退变性腰椎管狭窄症

目的回顾性分析选择性减压和减压融合治疗退变性腰椎管狭窄症的临床疗效。方法对我科2008年10月-2010年10月81例行手术治疗的退变性腰椎管狭窄症的临床资料进行总结：其中男37例,女44例,年龄39~72岁,平均（59.4±6.3）岁;单节段狭窄48例,双节段狭窄25例,三个及其以上节段狭窄8例;7例伴L4椎体I°滑脱,5例伴腰椎退变性侧弯,26例存在节段性不稳。根据无或有不稳行减压（A组）或减压融合（B组）。A组43例,行经后路常规椎板开窗减压或后路椎间盘椎管探查减压;B组38例,行后路减压椎体间或横突间植骨融合及椎弓根钉棒内固定术。采用JOA评分、ODI量表评价临床疗效,比较两组的疗效。结果平均随访1.8年,总体临床优良率82.1%,A组82.1%,B组82.2%。结论在仔细分析病情的基础上,选择个体化手术方案治疗退变性腰椎管狭窄症可取得满意的临床疗效,提高生活质量。

Individually surgical treatment for degenerative lumbar spinal stenosis

Objective To investigate therapeutic effects of selective decompression and fusion for degenerative lumbar cannal stenosis associated.Methods The retrospective analysis were performed on 81 patients admitted from October 2008 to October 2010 for spinal canal stenosis of retrograde degeneration,including 37 males and 44 females with an average age（59.4±6.3）years（from 39 to 72 years）.One level of stenosis was found in 48 Cases,two in 25 cases,and three or more in 8 cases.Of the 81 patients,7 were associated with grade I degenerative spondylolisthesis of L4,5 with degenerative lumbar scoliosis,and 26 with dynamic instability.The patients were divided into 2 groups.Group A（n=43）was treated by decompression and fusion,groupB（n=38）was treated by decompression,fusion and posterior instrumentation.The clinical outcomes were evaluated by Japanese Orthopedic Association（JOA）score and Oswestry Disability Index（ODI）to evaluate the clinical outcomes.Results Eighty one patients were followed up with an average of 1.5 years.The total good to excellent result was 82.1%,with 82.1%in group A and 82.2% in group B.There was no significant difference between the two groups.Conclusion This investigation suggests that the selected decompression and fusion for lumbar cannal stenosis can provide a good clinical outcome when the surgical plan is designed individually based on the careful evaluation of each patient＇s features.