有限减压腰椎后部结构重建治疗腰椎管狭窄症

Treatment of Lumbar Spinal Canal Stenosis by Limited Operation Decompression and Posterior Structure Rebuilding

广泛的腰椎后部结构切除治疗腰椎管狭窄后期出现医源性狭窄和腰椎失稳，为解决这一问题，作者设计了“有限减压腰椎后部结构重建术”，治疗节段性腰椎管狭窄。采用腰椎后正中手术切口，剥离一侧骶棘肌，切断棘突剥离对侧椎板，保留了棘上、棘间韧带和一侧组织的完整；手术中采用椎板间孔开窗减压，尽量保留腰椎后部结构骨性组织，切除导致狭窄的病理因素，将切断的棘突复位固定，重建脊柱后部结构。术后随访２０个月以上２８例，本组病人共减压６７个节段，平均每个患者重建２．５个节段。临床按日本骨科学会下腰痛治疗评价标准，改善率６２％～１００％，Ｘ线检查未见术后腰椎失稳。

Treatment of lumbar spinal canal stenosis with extensive removal of vertebral posterior structure always result in iatrogenic stenosis and vertebral instability.The authors designed a new operative method of decompression by limited operation and posterior structure rebuilding.Through lumbar posterior central incision,one side sacrospinal muscle was stripped,spinous process were cut off and the opposite side muscle was also stripped so supraspinal and interspinal ligamentsand the oposite side tissue were reserved.Decompression by fenestration between vertebral lamina was carried on,bone tissue of the vertebral posterior structure was reserved as possible,only pathologic factor caused stenosis was removed,spinous process cut off were reduced and fixed again.28 cases followed up over 20 months and 67 segments were decompressed(average 2 5 segment per patient).According to the evaluated standard of treating lower lumbago in Japanese orthopedic institute,the improvement rate was 62～100% and lumbar vertebra instability,was not happened.