退行性腰椎管狭窄症的手术方式选择及疗效分析

Selection of surgical methods and analysis of curative effect of retrograde lumbar spinal stenosis

目的了解不同术式下退行性腰椎管狭窄症的手术疗效。方法共收治98例退行性腰椎管狭窄症患者,所有患者经半年以上保守治疗无效后,根据影像学检查、临床表现和体征,以及患者的综合情况判定其腰椎退行性变发展的时期并并选择手术方式。其中椎板间开窗术（A组）11例,半椎板切除术（B组）44例,全椎板切除术（C组）29例,减压固定融合（D组）14例。结果随访6个月~8年,末次随访按改良Macnab疗效评定,四种手术方式的优良率分别为100%,97.8%,89.6%和85.6%。结论腰椎管狭窄症手术疗效的好坏与手术方式的选择有密切的关系,以腰椎退行性变的自然发展史为基础选择手术方式治疗腰椎管狭窄症可取得良好的疗效。

Objective To explore and compare the results of different surgical methods for treatment of retrograde lumbar spinal stenosis.Methods We treated 98 cases of retrograde lumbar spinal stenosis patients.All patients accepted conservative treatment more than 6 months and were proved ineffective.According to iconography,clinical manifestations and signs,as well as comprehensive conditions,we decided the period of development of lumbar degeneration and selected different surgical methods in which inter-laminar of vertebra fenestration（group A）were 11 cases,semi-laminectomy（group B）were 44 cases,total laminectomy（group C）were 29 cases,and decompression and fixation and fusion surgery（group D）were 14 cases.Results All patients were followed-up 6 months to 8 years,the final follow-up curative effect results were evaluated according to the modified Macnab,and excellent rates respectively in the four groups were 100%,97.8%,89.6% and 85.6%.Conclusion Operative effect has close relation to the choice of surgical methods,excellent results could be obtained when right surgical method was selected to treat lumbar spinal stenosis according to natural developing process of lumber degeneration.