影像学侧隐窝狭窄患者的病理类型和术式选择

Pathological Changes and Surgical Selection for Patients with Radiological Lateral Recess Stenosis

目的：探讨影像学侧隐窝狭窄腰腿痛患者的病理类型和术式选择。方法：对１３３例ＣＴ显示侧隐窝≤３ｍｍ的腰腿痛患者进行手术探查，根据神经根受压情况手术病理有３种类型：（１）椎间盘压迫型（６０％）；（２）侧隐窝及椎间盘共同压迫型（３２％）；（３）弥漫性神经根管狭小型（８％）。分别采用单纯开窗术、扩大开窗术和侧隐窝揭盖减压术进行治疗。结果：９０例平均随访２８个月，各组疗效优良率分别为８９％、８１％和８６％。结论：影像学侧隐窝狭窄与手术病理不完全一致，应根据不同病理类型选择术式。

Objective:To study the pathological changes and related surgical treatments for patients with radiological lateral recess stenosis.Methods:A series of 133 cases of low back pain with lateral recess values less than 3mm on the CT scan were explored operatively,the pathological changes were divided into three types according to the main origin of compression of nerve root:(1) Compression by herniated disc(60%);(2)Lateral recess stenosis with disc hernation(32%);(3)Diffused nerve root canal stenosis(8%).The related surgical modes were laminal fenestration,extensive laminal fenestration,and extensive decompresion of nerve root canal.Results:90 of the patients were followed up for an average of 28 months.The rates of excellent and good results were 89% (type 1),81%(type 2) and 86%(type 3).Conclusion:To select procedures based on pathological changes may get good decompression of nerve root and prevent instability of lumbar spine.