退变性腰椎管狭窄症的外科治疗

Surgical treatment of degenerative lumbar spinal stenosisshadow-defect

目的探讨退变性腰椎管狭窄症的手术治疗效果。方法退变性腰椎管狭窄症53例,单纯椎管减压15例,椎管减压并小关节、横突间融合11例,椎管减压并脊柱内固定融合27例(27例均行椎弓根螺钉内固定)。结果53例均获得随访,平均2.8年(1.5～6年),38例行融合术者37例获得一期骨性融合,另1例单枚圆柱型椎间融合器置入L4/5椎体间融合患者术后椎间融合器后退,再次手术,术后6月获骨性融合。采用JOA评分标准,手术后1年总体优良率75.5%。结论退变性腰椎管狭窄症的手术适应证应严格掌握,椎管减压后椎弓根螺钉内固定并脊柱融合可获得满意疗效。

Objective To study operative methods of degenerative lumbar spinal stenosis. Methods Spinal canal decompression were performed in all 53 eases, furthermore, 27 cases were treated with both transpedical screw system for internal fixation and interbody fusion device for interverterbral fusion, posterolateral fusion arthrodesis were performed in the other 11 cases without infernal fixation. Results In 53 cases, all were followed-up for an average of 2.8 years（ranged from 1.5years to 6 years）.Solid arthrodesis were obtained in 37eases at the first period,only 1 ease had the interbody fusion device back off and underwent secondary operation.According to JOA standards,the rate of the excellent and the good was 75.5%. Conclusion Internal fixation with transpedieal serewis and posterior interverterbral fusion after spinal canal decompression is recommended for the treatment of degenerative lumbar spinal stenosis.