手术治疗退变性腰椎管狭窄症的CT内切圆面积分析

Analysis of Surgery for Degenerative Lumbar Spinal Stenosis Disease CT Inscribed Circle Area

目的：探讨多节段椎板开窗潜行扩大术治疗退变性腰椎管狭窄症的临床疗效。方法：选取2011年6月-2014年12月采用多节段椎板开窗潜行扩大术治疗退变性腰椎管狭窄症患者60例,其中L3~4、L4~5节段22例,L4~5、L5~S1节段38例。所有患者手术前后均拍摄腰椎正侧位、过伸过屈位X线片及CT扫描片,运用CT图像分析软件测量手术前后椎管内切圆面积,同时对患者手术前后进行下腰痛评分（JOA）。结果：手术前后L3~4节段椎管内切圆面积比较[（68.205±21.854）mm2 vs（174.991±32.325）mm2],手术前后L4~5节段椎管内切圆面积比较[（71.160±19.794）mm2 vs（201.831±22.504）mm2],手术前后L5~S1节段椎管内切圆面积比较[（75.436±20.992）mm2 vs（208.233±17.750）mm2],以上指标比较差异均有统计学意义（P〈0.05）。手术前后JOA评分比较[（8.62±5.73）分vs（21.64±4.57）分],差异有统计学意义（P〈0.05）。结论：多节段椎板开窗潜行扩大术能有效解除患者腰椎病变部位对神经根及脊髓的压迫,充分改善了神经根、马尾神经的血液循环及功能。CT椎管内切圆面积能够很好的反映出多节段椎板开窗潜行扩大术的减压效果。

Objective： To explore clinical curative effect of more segmental lamina windowing stealth expand surgery for degeneratie lumbar spinal stenosis disease.Method： 60 patients with degenerative lumbar spinal stenosis disease were chose from June 2011 to December 2014,. they were treated with multi segmental vertebral lamina windowing stealth expand surgery. There were 22 cases of L3-4, L4-5 segments, 38 cases of L4-5, L5-S1 segments.All patients were taken before and after operation of lumbar positive side and through a bend a X-ray film and CT scans, CT image analysis software was used to measure before and after the operation, vertebral canal inscribed circle area, for the before and after operation in patients with low back pain score （ JOA ） .Result： Before and after operation, L3-4 segmental spinal canal inscribed circle area compared to each other [ （ 68.205 ± 21.854 ） mm^2 vs （ 174.991 ± 32.325 ） mm^2], before and after operation, L4-5 segmental spinal canal inscribed circle area compared to each other [ （ 71.160 ± 19.794 ） mm^2 vs （ 201.831 ± 22.504 ） mm^2], before and after operation, L5-S1 segmental spinal canal inscribed circle area compared to each other [ （ 75.436 ± 20.992 ） mm^2 vs （ 208.233 ± 17.750 ） mm^2], the above indexs were compared, the differences were statistically significant （ P〈0.05 ） . JOA score before and after operation were compared [ （ 8.62 ± 5.73 ） points vs （ 21.64 ± 4.57 ） points], the difference was statistically significant （P〈0.05） .Conclusion： Multiple segmental lamina windowing stealth expansion technique can effectively remove pathological changes of patients with lumbar nerve root and compression of the spinal cord, fully improve the nerve root, horsetail nerve blood circulation and function.CT spinal canals inscribed circle area can well reflect the lamina windowing stealth expand relief effect.