改良显微减压术治疗腰椎管狭窄症

Modified Microdecompression for Lumbar Spinal Canal Stenosis

目的总结改良显微减压术治疗腰椎管狭窄症的临床应用结果。方法 2004年1月至2008年12月对100例腰椎管狭窄症患者采用改良显微减压术治疗,其中男68例,女32例;年龄41～78岁,平均52岁。结果本组术后无神经损伤并发症,无伤口感染。手术时间50～90min,平均70min;术中出血量90～200mL,平均150mL。术后随访18～48个月,平均26个月。术后恢复率按Macnab评定标准进行疗效评定,优68例,良25例,差7例,优良率为93%。结论对腰椎管狭窄症的手术治疗重点应放在压迫引起症状的部位,而对无症状的部位不做预防性减压操作。改良显微减压术老年人更容易耐受,减轻了对腰椎后部结构的损伤,更容易进入椎管,有利于进行神经根减压。

Objective To summarize clinical application result of the modified microdecompression for lumbar spinal canal stenosis.Methods Between January 2004 and December 2008,100 patients with（68 men,32 women） with lumbar spinal canal stenosis underwent modified microdecompression.They ranged in age from 41 to 78 years（mean,52 years）.Results There was no neurologic injury complication in this series.None of the patients presented with wound infection after operation.The mean operation time was 70 minutes（50～90 minutes）,and mean intraoperative blood loss was 150 mL（90～200 mL）.Follow-up period ranged from 18～48 months postoperatively（mean,26 months）.The recovery rate was calculated with Macnab scores.The rates of excellent and good were 93%.Conclusion Operative treatment for lumbar spinal canal stenosis is focused at the areas causing sumptomatc neural compression rather than prophylactic decompression at areas of nonsymptomatic disease.The modified microdecompression procedures are more likely to be well tolerated by older patients and the damage to the posterior stabilizing structures of the lumbar spine can be minimized.This procedure allows easy access to the spinal canal and makes it easy to perform decompression of the nerve roots.