退行性腰椎管狭窄症采用不同手术方法治疗的临床观察

Surgical treatment for lumbar spinal stenosis by different methods

目的:探讨退行性腰椎管狭窄症的手术方法选择与疗效分析。方法:1996年9月至2007年3月共收治68例退行性腰椎管狭窄症患者,男40例,女28例;年龄32～78岁,平均52.8岁;平均病程51个月。依据Hansraj的经典与复杂型腰椎管狭窄症分型标准及引起症状的"责任"部位,经典的腰椎管狭窄症患者采用全椎板切除+根管扩大(A组18例)或半椎板切除+根管扩大(B组11例)及椎板间开窗+根管扩大(C组17例);复杂型腰椎管狭窄症患者行全椎板切除减压+椎弓根螺钉内固定+横突间、椎体间融合(D组22例)。采用日本骨科学会JOA15分法对术前和末次随访时的神经与自觉症状进行评估,计算改善率,并对结果进行统计学分析。结果:68例均获得随访,时间8个月～11年,平均64个月。末次随访时JOA评分改善率:A组(51.2±26.6)%,B组(60.7±21.1)%,C组(59.3±23.1)%,D组(59.1±22.7)%。均好于术前(P<0.001)。结论:CT和MRI等影像学检查结果与临床症状体征相结合是决定手术减压范围的关键;腰椎稳定与否是决定固定和植骨融合的关键。

Objective：To discuss the relationship between decompression methods of lumbar spinal stenosis and outcomes. Methods：From September 1996 to March 2007,68 patients with degenerative lumbar spinal stenosis were investigated retrospectively. There were 40 males and 28 females with the mean age of 52.8 years （ranging from 32 to 78 years old）. And the average history was 51 months. According to Hansraj classification of lumbar spinal stenosis and levels response to symptom,the classic lumbar spinal stenosis were treated with complete laminectomy and foramintomy （18 cases in group A）, hemilaminectomy and foreminotomy（11 cases in group B）,complete fenestration and foraminotomy（17 cases in group C）;and other patients with complicated lumbar spinal stenosis （22 cases in group D） were treated with decompression and intervertebral fusion and internal fixation. The clinical results of all patients were analyzed according to JOA score （15 scoring method）. Results：All patients were followed up with an average of 64 months （ranging from 8 months to 11 years）. At final follow up,the improvement rate of JOA score in the group A,B,C,D was respectively （51.2±26.6）%,（60.7±21.1）%,（59.3± 23.1）% and （59.1±22.7）%. These data were significantly difference than that of preoperative（P0.001）. Conclusion：CT and MRI results combining with clinical symptom and sign is the key to determine decompressive extent;lumbar stability is the key to determine fixation and intervertebral fusion in treating lumbar spinal stenosis