临床论著多节段经椎板间隙椎管扩大术治疗腰椎管狭窄症

Treatment of lumbar spinal stenosis by multiple segmental enlargement of the spinal canal with translaminar osteotomy

目的:探讨多节段经椎板间隙椎管扩大术治疗腰椎管狭窄症的疗效。方法:采用潜式扩大中央椎管和神经根管或摘除椎间盘术式治疗腰椎管狭窄症共86例。其中2节段减压57例,3节段减压19例,4节段减压10例。术后进行Oswestry疗效评分与影像学观察。结果:术后CT显示椎管直径明显增加,椎管造影显示神经根管明显扩大。术后1年随访79例,疗效优良率90.1%;术后3年随访76例,优良率86.3%。结论:多节段经椎板间隙椎管扩大术操作简单,手术并发症少,中央椎管和神经根管减压充分,对腰椎后柱张力带结构破坏小,治疗腰椎管狭窄症疗效满意。

Objective:To evaluate the surgical outcomes in patients with lumbar spinal stenosis treated by enlargement of the spinal canal through multiple segmental translaminar osteotomy.Method:Posterior central incision was used for bilateral exposure of laminae.Ligment um flavum was resected at the superior and inferior margin of lamina.Undermining enlargement of the central spinal canal and neural canal were then carried out;in some cases the intervertebral disc was resected.86 patients suffered from limbar stenosis were treated with the above procedure;among them decompression of two segments was done in 57 cases,three segments in 19 cases,four segments in 10 cases.Postoperatively,Oswestry evaluation score and imaging observation were carried out.Result:79 cases had follow-up for one year and the excellent and good results was seen in 90.1%.76 cases had follow-up for 3 years,the ecellent and good results was seen in 86.3%.both sagittal and transverse diameter of lumbar vertebral canal were increased notibly in postoperative CT scanning.Conclusion:Multiple segmental enlargement of the spinal canal with translaminar osteotomy for patients with lumbar spinal stenosis affords easy performing procedure with less complications and satisfactory surgical results.