全椎板切除术与腰椎不稳（附202例报告）

Total Laminectomy and Spinal Instability

作者通过对临床２０２例全椎板切除术后１～１０年的随访观察，再出现腰痛或（和）坐骨神经痛的发生率为７％（１５／２０２），术后腰椎滑脱或原滑脱加重的发生率为１．４％（３／２０２）。对于全椎板切除术，作者认为术前须全面准确地判断腰椎的稳定程度，严格掌握手术适应证以及在手术中尽可能地保留腰椎小关节和棘上韧带，全椎板切除术仍是一种既可达到充分减压，又可尽量保留脊柱稳定性的治疗方法。对术前已有腰椎不稳因素的患者，可以按照腰椎不稳的治疗原则采取相应的治疗措施。

AbstractThis is a retrospective study of 202 cases under-gone decornpression of the lumbar spinal canal stenosisand extraction of herniated disc during Octobor 1983to Octobor 1992.The decompression was performedhresection of the spinous process and lamina withpreservation of the facet joints。After the operation,15 cases(7%)experienced intractable back pain and 3cases(1.4%)had lumbar spondylolisthesis.The au-thors conclude that instabilitv of the lumbar spineshould be valuated preoperatively and the postopera-tive spondylolisthesis is avoidable in spinal stenosis de-compression operation,if extensive total facetectomyis only performed with strict indications and thepreservation of the facet joints and the supra spinal lig-ament should be emphasized.