不同类型退变性腰椎管狭窄症的手术治疗

SURGICAL TREATMENT FOR SPINAL CANAL STENOSIS OF RETROGRADE DEGENERATION

目的 通过对不同类型退变性腰椎管狭窄症手术方法的选择，提高手术治疗的疗效。方法回顾性分析2001年9月～2004年1月收治退变性腰椎管狭窄症患者96例，其中男85例，女11例。年龄39～71岁，平均54岁。病程3个月～7年。根据患者临床症状、体征及脊髓造影检查，分为5组，A组：1个节段椎间管狭窄，39例，行椎板间开窗椎间管（侧隐窝、神经根管）潜行扩大术；B组：1个节段中央椎管狭窄，21例，行椎板间开窗椎间盘摘除，椎间管潜行扩大术；C组：1个节段退行性脊柱滑脱，18例，行两侧椎板间开窗减压潜行扩大椎管后椎弓根钉系统内固定（AF、RF等）并横突间、小关节间植骨；D组：2个以上节段混合型椎管狭窄，ll例，行病变节段两侧开窗潜行扩大椎管，切除黄韧带，摘除椎间盘，松解神经根；E组：退行性脊柱侧突，7例，综合以上减压措施行椎弓根钉棒系统矫形内固定后外侧植骨。随访并评价其疗效。结果96例患者获随访6～36个月，平均12．2个月，未出现手术并发症。JOA评分优85例、良9例、中1例、差1例；X线片复查无椎弓根钉误置、断钉、拔出等。结论退变性腰椎管狭窄症的治疗采取有限化手术、有效化减压原则可减少并发症，提高疗效。脊髓造影对退变性腰椎管狭窄症的手术方式选择有重要价值。

Objective To investigate the surgical effect on different types of spinal canal stenosis of retrograde degeneration. Methods The retrospective analysis was performed on 96 patients （85 males, 11 females; average age 54, range 39-71） admitted from September 2001 to January 2004 for spinal canal stenosis of retrograde degeneration. The patients were divided into five groups according to their clinical symptoms and signs and the imaging of the spinal cord. In group A, 39 patients had one segment of the spinal canal stenosis and they underwent the recessively expanding operation through the intervertebral canal by opening a window between the vertebral plates. In group B, 21 patients had stenosis of the central vertebral canal of one segment and they underwent excision of the intervertebral disc through the window opened between the vertebral plates and the recessively expanding operation. In group C, 18 patients had degenerative spinal derangement of one segment and they underwent decompression through the window opened between the bilateral vertebral plates and the recessively expanding operation, and then underwent the internal fixation and bone grafting. In group D, 11 patients had the mixed stenosis of the vertebral canal of more than 2 segments and they underwent the recessively expanding operation through the window opened bilaterally on the diseased segment and excision of the yellow ligament and the intervertebral disc. In group E, 7 patients had degenerative lateral curvature of the spine and they underwent the combined surgical procedures including decompression, internal fixation, and bone grafting. All the patients were followed up after operation. Results The follow-up of the 96 patients for 6-36 months with an average of 12.2 months showed that they had no postoperative complications. According to the JOA Scoring, 85 patients had an excellent result, 9 had a good result, 1 had a fair result, and only 1 had a poor result. The X-ray films revealed no mistaken placing of the nails on the vertebral arch, broken nails or loosened nails. Conclusion The limited surgery and effective decompression can improve curative effects and reduce complications of spinal canal stenosis of retrograde degeneration. The imaging of the spinal cord has an important value in the choice of surgical protocols for spinal canal stenosis of retrograde.