选择性开窗潜行减压治疗退行性腰椎管狭窄症

Treatment of degenerative lumbar spinal canal stenosis with selective fenestration decompression

探讨退行性腰椎管狭窄治疗的手术方式 ,讨论本病的病理特点和采用选择性开窗潜行减压这一术式的可行性。方法 对 6 3例退行性腰椎管狭窄症患者 ,根据其术前CT等的定位、定性、定量及术中的具体所见 ,针对性地选择一侧或双侧 ,单个或多个开窗 ,行潜行减压治疗 ,并观察其后期疗效。结果 经治疗的 6 3例患者 ,开窗潜行减压基本上达到了满意的减压效果 ,疗效达优 2 7例 ,占42 8% ;良 33例 ,占 5 2 4% ;可 3例 ,占 4 5 % ;差 0例。结论 通过不同的开窗方式和多个开窗、有限的椎板及关节突切除、剥离和摘除退变增厚的黄韧带和椎间盘、潜行扩大椎管 ,能达到充分减压及尽量保留腰椎后部结构的双重目的 ,保证腰椎的稳定性 。

Objective To describe a surgical method for the treatment of degenerative lumbar canal stenosis,to study its pathologic features and to discuss the procudure of selective fenestration decompression.[HT5”H]Methods [HT5”SS]63 cases of degenerative lumbar canal stenosis were treated with one or double,single or multilevel widened fenestration decompression according to the location,nature and size of the stenosis shown in the pre operative CT examination and the intra operative findings.The post operative outcome were observed.[HT5”H]Results[HT5”SS] All the patients obtained effective decompression following widened fenestration.The outcome was excellent in 27 cases (42.8%),good in 33 cases (52.4%),fair in 3 cases (4.5%)and poor in none.Conclusion The widened fenestration included different modes of fenestrations,minimal resection of vertebral laminal and articular process,stripping and extirpating of degenerative and hypertrophic ligamentum flava and intervertebral discs.It could maintain spinal stability with effective decompression and avoid iatrogenic lumbar canal stenosis and lumbar spondylolisthesis.