两种手术方法治疗腰椎管狭窄症182例的临床研究

目的：通过精确责任神经根定位微创开窗减压和全椎板切除椎管减压椎弓根钉内固定术治疗腰椎管狭窄症的临床疗效，讨论两种方法的优缺点及适应证。方法：2007年3月～2013年3月收治的腰椎管狭窄症患者182例，男97例，女85例；年龄46～82岁，平均58．6岁。所有患者均行腰椎正侧、双斜、过伸、过屈位片及CT、MRI检查。中央管狭窄17例，侧隐窝狭窄95例，混合性狭窄70例，合并腰椎假性滑脱或不稳定者56例。患者分为：微创开窗减压治疗组88例，全椎板切除椎管减压椎弓根钉内固定术治疗组94例。结果：按NAKAI疗效评定标准，优良率：微创开窗减压组90．9％（80／88），全椎板切除椎弓根钉内固定术治疗组92．6％（87／94），两组优良率差异无显著性。微创开窗减压治疗组，手术时间、术中失血量、镇痛药使用、术后下床活动时间、住院时间均少于全椎板切除椎管减压椎弓根钉内固定术治疗组（P〈0．01），两组间脑脊液漏的发生率和术后疗效优良率差异无显著性（P〉0．05）。腰椎失败综合证3例发生于全椎板切除椎弓根钉内固定术治疗组。结论：微创开窗减压与全椎板切除椎管减压椎弓根钉内固定术治疗腰椎管狭窄症疗效无明显差异，微创开窗减压治疗腰椎管狭窄症创伤小，术后恢复快，疗效确切。全椎板切除椎管减压椎弓根钉内固定术应用于合并腰椎假性滑脱或不稳定患者更为合理。

Clinical study on two kinds of operation methods for treatment of 182 patients with lumbar spinal stenosis

Objective： To observe the clinical effects of the way of nerve root orientation, mini-incision de- compression by fenestration and the way of total laminectomy decompression with pedicle screw fixation for treatment of 182 patients with lumbar spinal stenosis. Meanwhile, discuss the advantages, disadvantages and indication of the two methods. Methods： From March 2007 to March 2013, 182 lumbar spinal stenosis pa- tients （including 97 male and 85 female, aging from 46 to 82 years） were taken lumbar X-rays, CT and MRI. Among them, central canal stenosis in 17, lateral recess stenosis in 95, mixed stenosis in 70, combined with lumbar false spondylolisthesis or instability in 56 cases. All Patients were divided into two groups, 88 patients in group A underwent mini-incision decompression by fenestration, and 94 patients in group B underwent total laminectomy decompression with pedicle screw fixation. Results： According to NAKAI standard, the excellent and good rate was 90.9% （80/88） in group A and 92.6% （87/94） in group B, no significant differences noted between the two groups. The time of operation, intraoperative blood loss, analgesics utilization, time of postoperative out-of-bed activity, time of hospitalization in group A were less than that in group B （P〈0.01）. There wasn＇t a significant difference between the two groups in the incidence rate of cerebrospinal fluid leakage, and the excellent and good rate of postoperative curative effect （P〉0.05）. Besides, lumbar failure syndrome happened in 3 cases of group B. Conclusion： There isn＇t a significant difference between the two treatment methods in treatment of patients with lumbar spinal stenosis. But, miniincision decompression by fenestration has the advantages of mini-trauma, faster postoperative recovery and a sure curative effect, and total laminectomy decompression with pedicle screw fixation is more reasonable for patients with lumbar false spondylolisthesis or instability.