椎板减压钛网椎管成形术治疗退行性腰椎管狭窄症的中期疗效

The middle term outcome of the treatment of spinal stenosis with titanium rete vertebral canaloplasty and decompessive laminectomy

目的 观察椎板减压钛网椎管成形术在治疗退行性腰椎管狭窄症的中期疗效。方法 选择2 8例退行性腰椎管狭窄症患者行椎板减压、钛网椎管成形术治疗 ,随访 3年～ 4年 6个月 (平均 4 1年 ) ,测量术前、术后 1年及术后最后一次随访时的腰椎管面积 ,记录患者主观对腰腿痛的Greenough和Fraser评分 ,进行统计学分析 ,比较术前、术后 1年及术后最后一次随访时上述数值的差异。结果 狭窄节段钛网椎管成形前横截面积为正常横截面积的 6 4 4 %± 9 8% ,术后 1年面积为 118 6 %±6 3% ,最后一次随访时为 12 1 9%± 10 1%。术前Greenough和Fraser评分为 2 6 3分± 6 9分 ,术后1年为 6 7 4分± 3 2分 ,最后一次随访时为 6 8 1分± 9 0分。椎管横截面积、Greenough和Fraser评分术后 1年与术后最后一次随访时比较差异无显著性 (P >0 0 5 ) ,但与术前比较差异均有显著性 (P<0 0 1)。结论 椎板切除钛网椎管成形术在治疗腰椎管狭窄症中 ,可以实现有效减压与脊柱稳定的重建 ,并可有效防止瘢痕组织对马尾与神经根的压迫 ,疗效满意 ,值得推广应用。

Objective To evaluate the middle term outcome of titanium rete vertebral canaloplasty for the spinal stenosis. Methods 28 cases of spinal stenosis were treated with decompressive laminectomy and titanium rete canaloplasty. All of the cases were followed up for 3～4 5 years (4 1 years on average). Before operation, one year after operation, and in the last follow up, the horizontal view of spinal canal was measured, and the patients subjective feeling of back and leg pain was evaluated with Greenough and Frasers scores, respectively. The data were compared with statistic analysis. Results The transverse area of the stenosed canal was 64 4%±9 8%, 118 6%±6 3% and 121 9%±10 1% of the normal part before operation, one year after operation and in the last following up respectively. The Greenough and Frasers scores were 26 3±6 9, 67 4±3 2, 68 1±9 0 at the corresponding time. There was significant difference between the data of preoperation and postoperation, but there was no significant difference between the two postoperative data. Conclusion It is effective to treat spinal stenosis with decompressive laminectomy and titanium rete vertebral canaloplasty, through which effective decompression and stable spine reconstruction can be obtained.