发育性腰椎椎管狭窄合并腰椎间盘突出症

Lumbar Disc Herniation in the Patients with Developmental Spinal Stenosis

目的：探讨发育性腰椎椎管狭窄合并腰椎间盘突出症的病理特点、诊断和治疗。方法：报告４２例发育性腰椎椎管狭窄合并腰椎间盘突出症，计男２９例，女１３例，年龄１９～４４岁，平均３１．７岁。均采用经椎板间开窗行椎间盘切除术治疗。结果：随访２～７年，平均４．４年。２８例术前症状完全消失，１３例根性疼痛或间歇性跛行症状消失但仍遗有腰痛，１例症状体征消失６年后又出现间歇性跛行。结论：腰椎椎管狭窄和腰椎间盘突出系两种独立的疾病，发育性椎管狭窄往往只是致病的条件而非决定因素。

Objective:To invetigate the pathological characteristics,diagnosis and treatment of lumbar disc herniation in patients with developmental spinal stenosis.Methods:Forty two lumbar disc herniations with developmental spinal stenosis were retrospectively reviewed and analyzed.There were 29 males and 13 females,aged 19 to 44 years (mean, 31 7 years). Discectomy was performed after laminotomy on all patients.Results:The patients were followed up for 2 to 7 years (mean,4 4 years). The preoperative symptoms disappeared completely in 28 patients,some degree of backache remained in 13 patients although the nerve root pain had been relieved and after 6 year resolution of the preoperative pain the intermittent claudication reappeared in one patient. Conclusion:Lumbar spinal stenosis and lumbar disc herniation are totally different pathological processes.Developmental stenosis of the lumbar spine is a conditional but not absolute determinant of neural compression.When developmental spinal stenosis is combined with disc herniation,discectomy through laminotomy rather than laminectomy is usually sufficient for decompression.