显微镜下微创减压治疗下腰退变性椎管狭窄症

Microscope-assisted minimally invasive decompression for degenerative lower lumbar spinal stenosis

目的:观察显微镜下微创减压治疗下腰退变性椎管狭窄症的临床疗效。方法:自2007年5月至2008年11月,显微镜下微创减压治疗下腰椎管狭窄症26例,男9例,女17例;年龄47～75岁,平均53.7岁;病程2～8年,平均3.6年;单侧症状20例,双侧6例。手术前后应用JOA法评价疗效并计算改善率。结果:单节段手术时间60～90min,平均75min,出血50～120ml,平均85ml;双节段手术时间80～180min,平均95min,出血60～150ml,平均100ml。26例均获得随访,时间6～24个月,平均8.6个月。按JOA评分法,优18例,良7例,差1例,优良率96%,平均改善率86%。术前评分3.92±0.83,术后12.67±1.92,差异有统计学意义(P<0.01)。结论:显微镜下微创减压手术治疗下腰退变性椎管狭窄症手术时间短、创伤小、操作精细、恢复快,同时可以获得良好疗效,但不适用于椎体后缘明显骨化或钙化、椎管内粘连较重的患者。

Objective：To evaluate clinical results of microscope assisted minimally invasive decompression for degenerative lower lumbar spinal stenosis. Methods：From May 2007 to November 2008,26 patients with degenerative lower lumbar spinal stenosis were treated with microscope assisted minimally invasive decompression. Including 9 males and 17 females,the mean age were 53.7 years （range in 47-75 years）. The course of disease was from 2 to 8 years with an average of 3.6 years. Single segment symptom had 20 cases and double segments had 6 cases. The clinical effects were evaluated and improvement rate was calculated according to JOA scoring before and after operation. Results：The operative time in single segment was 60-90 minutes with an average of 75 minutes and in double segments was 80-180 minutes with an average of 95 minutes. The operative bleeding in single segment was 50-120 ml with an average of 85 ml and in double segments was 60-150 ml with an average of 100 ml. All the patients were followed up with an average of 8.6 months （range in 6-24 months）. The clinical effects were evaluated according to JOA scoring,excellent in 18 cases,good in 7,poor in 1,the rate of excellent and good was 96% and improvement rate was 86%. The mean JOA scoring was respectively 3.92±0.83 and 12.67±1.92 before and after operation. There was significantly statistic difference between before and after operation（P0.01）. Conclusion：Microscope assisted minimally invasive decompression for degenerative lower lumbar spinal stenosis can obtain satisfactory therapeutic effect,which had advantages of short operative time,less trauma,subtle operation,fast restoration,but it is inapplicable for the patients with obviously ossification or calcification of vertebral body,severe vertebral canal adherence.