退变性腰椎管狭窄症的手术治疗及其疗效

Surgical treatment for patients with degenerative lumbar spinal stenosis

[目的]回顾性分析退变性腰椎管狭窄症的手术方法及其疗效。[方法]对本院1998年10月～2006年7月间81例行手术治疗的退变性腰椎管狭窄症病例的临床资料进行总结:其中男37例,女44例,年龄39～72岁,平均(59.4±6.3)岁;单节段狭窄48例,二节段狭窄25例,三个及以上节段狭窄8例;7例伴有L4Ⅰ度退行性滑脱,5例伴有腰椎退变性侧弯,26例存在病变节段的动力性不稳。根据是否辅以内固定分为两组:A组:43例,行后路减压后外侧融合;B组:38例,行后路减压后外侧融合加椎弓根钉内固定。临床疗效评估采用医生测评(Fischgrund JS标准)和患者自评(SF-36问卷)两项指标,比较两组的疗效。[结果]平均术后随访4.8年,总体临床优良率71.6%,其中内固定组优良率71.0%,无内固定组72.1%,内固定组与无内固定组差异无统计学意义(Z=0.0358,P>0.05);SF-36各项指标术后均有明显提高(P<0.01),内固定组与无内固定组差异仍无统计学意义(t=1.67,P>0.05)。[结论]退变性腰椎管狭窄症手术治疗可望获得良好的疗效,辅以内固定并不一定能提高临床疗效,是否辅以内固定应谨慎选择。

[Objective] To evaluate the clinical outcome of degenerative lumbar spinal stenosis. [ Method] From October 1998 to July 2006, 81 DLSS（ degenerative lumbar spinal stenosis）patients underwent posterior decompression, fusion with or without instrumentation, including 37 males and 44 females with an average age of 59.4 ± 6.3 years （ from 39 to 72 years）. One level of stenosis was found in 48 cases, two in 25 cases, and three or more in 8 cases. Of the 81 patients, 7 were associated with grade I degenerative spondylolisthesis of L4, 5 with degenerative lumbar scoliosis,and 26 with dynamic instability. The patients were divided into 2 groups. Group A （n =43） was treated by decompression and fusion and group B （n =38 ） was treated by decompression, fusion and posterior instrumentation. Both surgeon- based（ Fischgrund JS Standard） and patient- based（ SF -36 Questionnaire） standards were used to evaluate the clinical outcomes. [ Result] Eighty -one patients were followed up with an average of 4.8 years. The total good to excellent result was 71.6% with 72.1% in group A and 71.0% in group B. There was no significant difference between the two groups （ Z = 0. 0358, P 〉 0.05 ）. SF - 36 data revealed significant postoperative improvement （P 〈 0.01 ）. No significant difference was found between groups with or without instrumentation （ t = 1.67, P 〉 0. 05 ）. Main complications included deep infection in one case, deterioration of spondylolisthesis in two cases, conjunctional stenosis in one case, and broken pedicle screws in two cases. Six patients received revision surgery. [ Conclusion] Surgical treatment of DLSS may result in satisfactory outcome. Transpedicular screw fixation may not improve the clinical outcomes and posterior instrumentation should be adopted cautiously and properly.