老年性腰椎管狭窄症手术方式的选择

Senile Lumbar Spinal Stenosis Surgical Approach Selection

目的:探讨老年性腰椎管狭窄症的手术治疗效果。方法根据患者术前的症状和影像学资料,选择病变部位脊柱内固定的节段,单侧下肢麻痛者只作单边的椎板切除和神经根减压术,保留对侧椎板作植骨床,如果是双下肢的症状者就选择全椎板切除双侧神经根减压术,椎体间植骨的方法,在行椎体间固定前先将椎体间纵向撑开2~3 mm再固定。结果本组患者腰腿痛症状都得到不同程度的缓解,无死亡病例。随访6~12个月、平均8个月53例。按腰腿痛JOA评分标准:28分31例、26分16例、22分5例、18分1例。其中1例术后7个月内固定物松动给予取出。植骨融合良好,无内植物断裂现象。结论在老年性腰椎管狭窄症的手术治疗方面,在确保患者手术安全的前提下,其目的主要是解决患者的腿痛和相应的腰痛。手术方式的选择不能根据影像学的异常决定方案,要根据患者的症状进行选择。这样才能取得安全有效的结果。

Objective:To determine the surgical results of senile lumbar spinal stenosis.Methods:Dif erent internal fixation segments were choosed according to the preoperative symptoms and the imaging data of patients.Cases with unilateral symptom of lower limb were treated by semi-laminectomy and nerve root decompression.The opposite sides of vertebral lamina were used for bone graft fusion.Cases with bilateral symptoms underwent the whole laminectomy and bilateral nerve root decompression accompanied by interbody fusion.The rods were distracted to 2-3mm before firmly fixation.Results:The symptom relief was found in al cases in dif erent degree and no death case.Fol ow-up period ranged from 6 months to 12 months with a mean fol ow-up time of 8 months.According to JOA scoring:28 in 31 cases,26 in 16 cases,22 in 5 cases,18 in 1 case.The internal fixation was taken out in 1 case because of postoperative loosening after 7 months.Al cases showed bony fusion and no internal fixation breakage.Conclusions:On the premise of safety,the purpose of the operation about senile lumbar spinal stenosis is mainly to al eviate lumbocrural pain.The choice of the ways of operation should depend on not the imaging data but the symptom.Then the security and good clinical ef ects can be ensured.