多节段腰椎管狭窄症的治疗探讨

目的探讨多节段腰椎管狭窄症的手术方法,提出预防腰椎管狭窄症的措施。方法根据多节段腰椎管狭窄的成因、形式、范围和程度的不同采取不同的减压术式:全椎板切除治疗单纯中央管狭窄7例;全椎板切除+小关节部分切除治疗严重的退变性中央管狭窄伴侧隐窝狭窄、神经根管狭窄和腰椎手术失败综合征(FBSS)引起的多节段继发性腰椎狭窄共12例;椎板间隙潜行扩大减压治疗椎板间水平的中央管狭窄伴侧隐窝狭窄、神经根管狭窄11例;半椎板切除和(或)交叉半椎板切除+小关节部分切除治疗中央管一侧狭窄伴侧隐窝狭窄、神经根管狭窄8例;椎板开窗成形减压术治疗侧隐窝狭窄、神经根管狭窄20例。同时行椎间盘突出髓核摘除38例,合并腰椎不稳者行椎间、椎旁植骨融合或椎间融合器融合12例(内固定11例)。结果本组58例,平均随访3年9个月。疗效评定优良率86.2%。结论针对性减压治疗多节段腰椎管狭窄症手术疗效满意,并可减少继发性腰椎不稳和再狭窄发生率。

Surgical Strategy of Multi-level Lumbar Spine Stenosis

Objective To explore decompressive treatments of multi-level lumbar spine stenosis and propose prophylaxis procedures.Method Decompressions according to the causes,classification,extension and degree:7 simple stenosis cases with full laminectomy,full laminectomy plus facet partly excision of 12 cases of severe degenerative stenosis with lateral recess stenosis,nerve root canal compression as well as Failed Back Surgery Syndrome,prowling laminectomy in 11 cases of laminar level stenosis with lateral recess stenosis and nerve root canal,semilaminectomy and/or contralateral semilamiectomy with facet partly excision in 8 cases with lateral stenosis,lateral recess and nerve root canal stenosis,laminectomy and laminoplasty in 20 cases with lateral recess and nerve root canal stenosis.Simultaneously,discectomy was done in 38 cases,intervertebral,lateral or cage fusion in 12 unstable cases,11 cases of which were internal fixed.Results 58 cases were followed for an average of 3.9 years.86.2% of the cases were assessed as excellence.Conclusion Decompressive treatment of multi-level lumbar spine stenosis is satisfactory,which can reduce the secondary lumbar instability and the incidence of restenosis.