棘突截骨椎管成形术治疗单纯性腰椎管狭窄症

Spinous Process Osteotomies and Canaloplasty for Simple Lumbar Stenosis

目的 采用棘突截骨椎管成形术治疗单纯性腰椎管狭窄症 ,并进行临床与影像学评估。方法 手术方法为单侧椎板显露棘突基底截骨 ,将棘突 -韧带 -骶棘肌整体推离对侧椎板。切除椎板上下缘和黄韧带 ,潜式扩大椎管和摘除椎间盘。 35例退行性腰椎管狭窄症患者接受该手术 ,术后进行疗效评分 (Oswestry问卷 )和腰椎管直径测量。结果 术后 1年腰腿痛平均改善78.4% ,术后 4年平均改善 76 .3 % ,术后中期疗效下降不显著 (P >0 .0 5 )。术后CT显示椎管矢径平均增加 19.7% ,横径平均增加 17.5 % ,棘突截骨后原位愈合率为 91%。结论 棘突截骨椎管成形术操作简单 ,神经减压充分 ,手术并发症少 ,腰椎稳定性破坏轻。该术式治疗单纯性腰椎管狭窄症术后近。

Objective To describe a technique that affords wide decompression of lumbosacral nerves, and to investigate the outcomes of its application in simple lumbar spinal stenosis.Methods Spinous process osteotomies and spinal canaloplasty for lumbosacral nerves decompression were taken in 35 patients. The surgical outcomes were followed up for one to four years with Oswestry questionnaire and radiological findings.Results The functional improvement was 78.4% one year after surgery, and 76.3% four years after surgery. The sagittal and coronal diameter of spinal canal was increased by 19.7% and 17.5% respectively in postoperative CT scanning. The 91% of osteotomized spinous processes had bony fusion with retain lamina bridge.Conclusion Spinous process osteotomies and canaloplasty for lumbosacral nerves decompression affords easy performing, seldom complications, excellent decompression, minimizing destruction to the innervations of the paraspinal musculature as well as the ligaments complex. The surgical outcomes of patients suffered from simple stenosis of lumbar spinal is satisfactory in early and mid term clinical and radiological evaluation.