退变性腰椎管狭窄症的手术方式选择(附127例临床分析)

Evaluation of Surgical Decompression for the Treatment of Lumbar Spinal Stenosis (A Clinical Analysis of 127 Cases)

目的探讨腰椎管狭窄症的诊断与手术指征、减压范围、固定融合与疗效的关系。方法 回顾分析127例退变性腰椎管狭窄症患者,平均年龄53.4岁,平均病程51个月。手术方式:A组:全椎板切除+根管扩大31例;B组:半椎板切除+根管扩大23例;C组:椎板间开窗+根管扩大48例;D组:全椎板切除减压+椎弓根钉内固定+横突间植骨25例。结果 127例平均随访62个月,四种手术方式优良率分别为77.4％、82.6％、89.6％、84％,并发症发生率分别为22.6％、17.4％、12.5％、16％。结论 临床症状对日常生活的影响程度是决定手术与否的关键;CT和MRI等影像检查显示的狭窄因素与症状体征的一致性是决定手术减压范围的关键;腰椎稳定与否是决定固定和植骨融合的指征。

Objective To discuss the relationship between decompression methods of lumbar spinal stenosis and outcomes. Methods One hundred and twenty - seven cases of lumbar spinal stenosis underwent operation were investigated retrospectively. The average age was 53. 4years. And the average history was 51 months. Among them, 31 cases were treated with complete laminectomy and foramino-tomy. Twenty - three cases were treated with hemilaminectomy and foraminotomy. Forty - eight cases were treated with fenestration and foraminotomy. Other 25 cases were treated with decompression and internal fixation with bone graft fusion. Results With a mean follow - up period of 62 months, The satisfactory rate of the four methods were 77.4%、 82.6% 、 89.6% and 84 % , and the incidence of complications were 22.6% 、 17.4%、 12.5% and 16% respectively. Conclusion That clinical symptoms and signs are identical with radiology is the key to determine the operation methods for the lumbar spinal stenosis.