后路椎间盘镜治疗中央型腰椎管狭窄症

Central lumbar spine stenosis treated by posterior microendoscope.

目的 探讨后路椎间盘镜治疗中央型腰椎管狭窄的手术方法和适应症。方法 对我院骨科 2 2例施行后路腰椎间盘镜治疗的中央型腰椎管狭窄病例进行回顾性分析 ,男 16例 ,女 6例 ,年龄 3 9～ 68(平均 46 5 )岁。均有下肢痛和间歇性跛行 ,经MRI和CT检查确定。L4,5狭窄 8例 ,L5S1狭窄 5例 ,L4,5合并L5,S1狭窄 9例。手术方式 :双侧半椎板切除减压术 14例 ,单侧入路减压手术 8例。结果 按Nakai疗效评定标准 ,优 15例 ,良 5例 ,可 1例 ,差 0例。 2例脑脊液漏 ,1例神经根挫伤。结论 后路椎间盘镜治疗中央型腰椎管狭窄可以有效地保留棘间和棘上韧带 ,对关节囊破坏小 ,因而对脊柱的稳定性损害小。该手术疗效明确 ,恢复时间短。

Objective To explore the operative method and indication of microendoscope in the treatment of central lumbar spine stenosis.Methods The clinical data were reviewed in 22 central lumbar spine stenosis cases who had undergone posterior microendoscope treatment.Male 16,Famale 6,aging from 39 to 68(mean 46.5).All cases had lower extremity pain and pseudoclaudication.Computed Tomography(CT)and Magenetic Resonance Imaging(MRI)studies showed that there were 8 cases of L 4,5 stenosis,5 cases of L 5S 1 stenosis ,9 cases.of L 4,5 stenosis combined L 5S 1 stenosis. 14 cases had bilateral decompressive semilaminectom,and 8 cases had lateral decompressive laminectomy.Results The evaluation with Nakai scale revealed excellent result in 15 cases,good in 5 cases,fairly good in 1 cases,and there was no poor result.2 cases had the complication of cerebrospinal fluid leak and 1 case had contusion of nerve root.Conclusion The treatment of central lumbar spine stenosis with posterior microendoscope effectively reserved interspinal ligament and supraspinal ligament and had little damage on facet capsule and spinal stability.The central lumbar spine stenosis treated by microendoscope is an effective method and the patients can recover rapidly,howerer the indication should be strictly evaluated.