椎板节段开窗治疗腰椎管狭窄症的远期疗效

Long-term Outcome of Multiple Laminectomy for Lumbar Spinal Stenosis

目的探讨分析椎板节段开窗减压治疗腰椎管狭窄症的远期疗效及影响因素.方法 1992～2000年连续收治的132 例腰椎管狭窄症患者,男72 例,女60 例,年龄41～81 岁,平均59 岁.病程6个月～24 a,平均29个月.有不同程度的腰腿痛和间歇性跛行,伴有系统性疾病者为75.8%.影像学示退行性114 例,发育性7 例,混合性11 例,其中11 例伴有Ⅰ°退行性滑脱.结果随访48～142个月,平均78个月,优良率83.5%.3 例Ⅰ°退行性滑脱患者进行了二次手术治疗.结论椎板节段开窗椎管潜行式扩大减压是治疗退行性腰椎管狭窄症的有效术式,远期疗效与腰椎不稳、年龄及手术技术相关.

Objective To evaluate the long-term outcome and influence factors of prognosis by using decompressire fenestration for lumbar spinal stenosis. Methods One hundred and thirty two consecutive patients who underwent decompression surgery were included in the retrospective study, 72 males, 60 females, age from 41 to 81 years, mean age 59 years. Preoperative duration of symptom was 6~24 months, the mean was 29 months. Radiographic evaluation was used to determine the constriction of spinal canal. Clinical function of pre- and post-operation were determined by using a scoring system proposed by Japanese Orthopaedic Association（JOA score）. Results The range of follow-up from 48 to 142 months with a average of 78 months. Of these 132 patients, 53 patients（40.2%） had excellent results, 57（43.2%） good, 18（13.6%） fair and 4（3%）poor. During the follow-up period, three of 11 degenerative spondylolisthesis patients underwent reoperation, aII consisting of fusion and instrumentation. Conclusion Multiple lamonotomy is a reliable procedure for management of lumbar spinal stenosis. There was a significant correlation between good result and lumbar spinal stability in long-term follow-up. Other prognostic factors were age and surgical technique. Multiple lamonotomy is safe alternative to laminectomy in a properly selected cases.