多节段椎管扩大减压治疗退行性腰椎管狭窄症

TREATMENT OF DEGENERATIVE LUMBAR SPINAL STENOSIS THROUGH MULTILEVEL PARITAL LAMINECTOMY WITH UNDERMINING ENLARGEMENT OF LUMBAR CANCAL

目的 观察多节段椎板部分切除 ,椎管潜行式扩大减压成形治疗退行性腰椎管狭窄症的疗效 ,并评估其优缺点。方法 自1 993年 4月— 1 999年 4月采用该术式治疗退行性腰椎管狭窄症 50例 ,其中术前有腰椎不稳 4例 ,观察其疗效。结果 平均手术时间90min ,失血量 2 80ml,减压节段共 1 2 6段 ,平均 2 .52节段 ,术中并发症 4例 ,3例硬脊膜撕裂和 1例神经根损伤 ,50例患者随访 1 2～ 46个月 ,平均 2 8个月 ,术后腰椎不稳 1例 (2 % ) ,按日本骨科学会 (JOA)腰痛疾病治疗成绩评估标准 :优 38例 (78% ) ,良 6例 (1 2 % ) ,可 6例 (1 2 % ) ,术后无症状加重和病情恶化。结论 结果表明本术式是治疗退行性腰椎管狭窄的一种安全。

Objective To demonstrate the effect of multilevel parital laminectomy with undermining enlargement of lumbar cancal for the treatment of degenerative lumbar spinal stenosis. Methods From April 1993 to April 1999, 50 patients with degenerative lumbar spinal stenosis reveived multilevel parital laminectomy with undermining enlargement of lumbar cancal, 4 of whom suffered from unstable spinal lumbar before operation. Observations were carried out concerning the curative effect. Results The average operative time was 90min with blood loss 280ml. 126 sections were decompressed, with an average of 2.52 per person. Complications during the operation occurred to 4 cases, including 3 dural matter tears and 1 nerve root injury. Follow-up visits for 12～46 months, with an average of 28 months, for the total 50 patients showed that only one patient (2%) suffered from spinal instability. According to assessment criteria stipulated by JOA, 38 cases (78%) resulted in A (excellent); 6 (12%) resulted in B (good); the other 6 (12%) resulted in C (moderate). No post operative deterioration occurred. Conclusion Multilevel parital laminectomy with undermining enlargement of lumbar proved to be an effective, simple and safe management for the patients with degenerative lumbar spinal stenosis.