经峡部入路治疗腰椎管狭窄症

Treatment of lumbar spinal canal stenosis with the par interarticularis approach

目的总结经峡部入路治疗腰椎管狭窄症的临床应用结果。方法 2005年1月～2008年12月,对122例腰椎管狭窄症患者采用改良显微减压术治疗。其中,男88例,女34例。年龄49～78岁﹙平均56岁﹚。结果本组术后无神经损伤并发症,无伤口感染。手术时间50～90分钟﹙平均70分钟﹚,术中出血量90～200m﹙l平均150ml﹚。术后随访22～52个月﹙平均30个月﹚。术后恢复率按Macnab腰椎管狭窄疗效评定标准对疗效进行评定评,优良率为94%,未发生与手术相关的并发症。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。经峡部入路术式老年人更容易耐受,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 treatment of lumbar spinal canal stenosis with the par interarticularis approach.Methods Between Jan 2005 and Dec 2008,122 patients with（88 men,34 women）with lumbar spinal canal stenosis were treated with the par interarticularis approach.They ranged in age from 49 to 78 years（mean,56y）.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（90～200ml）.Follow-up period ranged from 22～52 months postoperatively（mean,30months）.The recovery rate was calculated with Macnab scores.The rates of excellent and good were 94%.There were not any surgery related complications.Conclusion Operative treatment for lumbar spinal canal stenosis is focused at the areas causing symptomatc neural compression rather than prophylactic decompression at areas of nonsymptomatic disease.The treatment of lumbar spinal canal stenosis with the par interarticularis approach 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.