多节段椎板开窗潜行扩大术治疗退变性腰椎管狭窄症的CT椎管测量分析

More segmental lamina windowing stealth expand surgery treatment of degenerative lumbar spinal stenosis CT measurement and analysis

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2013-03-2015-09甘肃省中医院脊柱骨三科所收治的退变性腰椎管狭窄症患者100例,所有患者均采用多节段椎板开窗潜行扩大术治疗,手术前后运用Digimizer图像分析测量软件对100例患者的CT扫描片进行椎管矢径、椎板间距、上关节突内缘间距、椎管截面积测量,同时对患者手术前后进行JOA评分(日本骨科学会下腰痛评分法)。结果术后L_(3-4)、L_(4-5)、L_5-S_1各平面的椎管矢径较术前平均增加4.823 mm、5.585 mm、5.517 mm;术后L_(3-4)、L_(4-5)、L_5-S_1各平面的椎板间距较术前平均增加7.134mm、5.998 mm、5.143 mm;术后L_(3-4)、L_(4-5)、L_5-S_1各平面的上关节突内缘间距较术前平均增加7.231mm、7.046 mm、6.052 mm;术后L_(3-4)、L_(4-5)、L_5-S_1各平面的椎管截面积较术前平均增加183.818 mm^2、202.435 mm^2、177.953 mm^2,且P<0.05,具有统计学意义。手术前后JOA评分,由术前的(8.63±1.83)分升高到术后的(26.33±1.53)分(P<0.05)具有统计学意义;JOA评分改善率为86.90%。结论多节段椎板开窗潜行扩大术减压充分,能明显扩大病变节段的椎管矢径、椎板间距、上关节突内缘间距及椎管截面积,解除了患者的临床症状,疗效可靠。

Objective To explore more segmental lamina windowing stealth expand surgery treatment of degeneratie lumbar spinal stenosis disease clinical curative effect. Method Select 2013- 03-2013-09 Gansu province hospital of traditional Chinese medicine spine bone third department treatment of 100 patients with degenerative lumbar spinal stenosis disease,all the patients through multiple segmental lamina windowing stealth expanded surgical treatment,before and after the surgery, 100 patients were measured with Digimizer image analysis to measure the software of the CT scans, the vertebral canal sagittal diameter, vertebral plate distance, articular process .of measure distance, cross-section of spinal canal,at the same time, the patients JOA score before and after operation. Result After surgery, L3-4, L4-5 and L5-S1 vertebral canal sagittal diameter of each plane compared with before the operation, the average increase of 4.823 mm,5.585 mm and 5.517 ram;After surgery, L3-4, L4-5 and L5-S1 vertebral plate spacing of each plane with preoperative average increased by 7.134 mm, 5.998 mm and 5.143 mm;Mter surgery, L3-4. L4-5 and L5-S1 articular process on the inside edge distance of each plane compared with preoperative average increased by 7.231 mm, 7.046 mm and 6.052 mm;After surgery, L3-4, L4_5 and L5-S1 vertebral canal section area of each plane, compared with before the operation on average increased by 183.818 mm2, 202.435 mm2 and 177.953 romE, and P〈 0.05,have statistical significance.Compare JOA score before and after operation,from （8.63±1.83） points to （26.33 ±1.53）points,P〈0.05,have statistical significance;through the JOA score before and after treatment,computing to improve the ratio,the results of 86.90%. Conclusion More segmental lamina windowing stealth to expand the operation can reduce stress,can significantly expand lesion segment of the vertebral canal sagittal diameter, vertebral plate spacing, articular process of spacing and vertebral canal area,remove the patient＇s clinical symptoms,the curative effect is reliable.