退变性腰椎管狭窄症手术治疗的现状和研究进展

Current Status and Research Progress of Surgical Treatment of Degenerative Lumbar Spinal Stenosis

椎管狭窄症(lumbar spinal stenosis,LSS)是由软组织和骨骼增厚引起的下背部区域的椎管狭窄,大多数LSS病例是由于脊柱老化导致的获得性退行性狭窄,临床表现为慢性疼痛和残疾,显著降低老年人的生活质量、活动能力和腰椎功能。通常在非手术治疗(如物理治疗)未能给患者带来足够的缓解后进行手术,目前,尚无足够的证据表明有明显效果的保守治疗方案,故手术治疗仍是该疾病治疗的主要措施。LSS手术旨在减压狭窄的椎管并保持脊柱稳定性。LSS包括通过去除椎管周围的骨骼和软组织来减轻脊髓或脊神经的压力的椎管减压术,减压后将两个或多个椎骨融合在一起的腰椎融合术以及脊柱植入物以帮助间接降低椎管中压力和稳定骨骼的棘突间装置。本研究对近年来腰椎管狭窄症的手术治疗方法应用现状和研究进展进行总结,分析各种手术方法的应用优势,为临床医生制定相关诊疗方案提供临床参考,研究结果表明,目前减压加融合和棘突间隔离物并没有显示出优于单独的传统减压。在这个领域需要更严格的方法研究来证实本研究。

Lumbar spinal stenosis(LSS)is a narrowing of the spinal canal in the lower back region caused by soft tis⁃sue and bone thickening.Most cases of LSS are due to acquired degenerative stenosis due to aging of the spine,clini⁃cally manifested as chronic pain and disability,significantly reducing quality of life,mobility,and lumbar spine func⁃tion in older adults.Surgery is usually done after nonsurgical treatments,such as physical therapy,have failed to bring the person enough relief.At present,there is not enough evidence to show that there is a conservative treatment plan with obvious effect,so surgery is still the main measure for the treatment of this disease.LSS surgery aims to decom⁃press a narrowed spinal canal and maintain spinal stability.LSS involves decompression of the spinal canal to relieve pressure on the spinal cord or spinal nerves by removing bone and soft tissue around the spinal canal.Lumbar fusion,which fuses two or more vertebrae together after decompression,and spinal implants to help indirectly reduce pressure in the spinal canal and interspinous devices that stabilize the bones.This study summarizes the application status and research progress of surgical treatment methods for lumbar spinal stenosis in recent years,analyzes the application ad⁃vantages of various surgical methods,and improves clinical reference for clinicians to formulate relevant diagnosis and treatment plans.The research results show that,currently,decompression plus fusion and interspinous barriers have not been shown to be superior to conventional decompression alone.More rigorous methodological studies are needed in this area to confirm the results.