摘要
目的:总结腰椎棘突劈开、椎管减压术治疗腰椎管狭窄症的优缺点及手术疗效。方法:2008年4月～2009年4月采用棘突劈开、椎管减压术治疗退变性腰椎管狭窄症28例,男16例,女性12例;年龄40～71岁,平均63.1岁;病程0.3～10年,平均8.5年。单节段6例,双节段18例,3节段4例;L3/4 20例,L4/5 28例,L5/S1 6例,9例合并腰椎间盘突出。术前单侧下肢麻木、疼痛者22例,双侧6例。步行距离10～1000m,平均315m。术前JOA评分10.3±1.4分,腰痛、下肢痛及下肢麻木VAS分别为4.6±0.7分、7.7±1.0分和6.1±2.3分。术后第3天行血肌酸激酶(CPK)测定。术后定期随访患者症状改善情况和影像学改变。结果:手术时间65～175min,平均115±5.6min,术中失血量50～500ml,平均116±12.5ml,单、双及3节段平均显露时间分别为11.3±2.0min、20.2±2.6min及26.1±2.1min。术后第3天CPK为336±16.1u/L。术后3个月随访时,1例劈开棘突因缝合不当未完全愈合,其余患者劈开棘突均一期愈合。随访16～36个月,平均25.3个月,末次随访时JOA评分24.7±3.5分,改善率为(77.0±3.1)%,腰痛、下肢痛及下肢麻木VAS分别为1.6±0.7分、1.1±0.3分及2.5±1.3分,均较术前显著改善(P<0.05)。未出现腰椎不稳,多裂肌无明显萎缩。结论:棘突劈开椎管减压术能保护双侧多裂肌,有效减少术后腰痛,是治疗退变性腰椎管狭窄症的有效方法。
Objective：To investigate the clinical outcome of lumbar spinous process-splitting laminectmny for lumbar spinal canal stenosis.Method：28 cases of lumbar spinal canal stenosis,including 16 males and 12 females with the average age of 63.1 years （range,40-71 years）were reviewed retrospectively.The average dura- tion of symptoms was 8.5 years（range,0.3-10 years）.The number of involved discs was one in 6 cases,two in 18 cases and three in 4 eases,and the affected levels were L3/4 in 20,L4/5 in 28 and L5/S1 in 6 cases.22 cases had unilateral and 6 cases had bilateral sciatica pain.The mean walking distance due to NIC was 315 meters （range,10-1000m）.A]l patients underwent lumbar spinous process-splitting laminectonly.The mean preoperative JOA score,VAS for low back pain,leg pain and numbness were 10.3±1.4,4.6±0.7,7.7±1.0 and 6.1± 2.3 respectively.The CPK level was measured 3 days after operation.The postoperative radiographic findings and function improvement were recorded during follow-up.Result：The mean operation time aud blood loss were 115±5.6min （65-175min） and 116±12.5ml （50-500ml） respectively.The exposure time of single,double and three levels was 11.3±2.0min,20.2±2.6min and 26.1±2. hnin respectively.Three days after surgery,the CPK was 336±16.1u/1.27 cases except I ease had splitting spinous process united three months later under computed tomography.The mean follow-up was 25.3 months（16-36 months）,the JOA score,improve rate,VAS for low back pain,leg pain and numbness at final follow-up were 24.7±3.5, （77.0±3.1）%,1.6±0.7,1.1±0.3 and 2.5± 1.3 respectively.The postoperative JOA scores and VAS scores improved significantly than preoperative ones （P〈0.05）.No lumbar instability and lumbar muhifidus muscle atrophy was noted.Conclusion：Lumbar spinoas process-splitting lamineetomy can effectively protect bilateral muhifidus and decrease the occurrence of postoperative low back pain,which is effective for managing lumbar spinal stenosis.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
北大核心
2011年第8期650-653,共4页
Chinese Journal of Spine and Spinal Cord
关键词
腰椎管狭窄症
棘突劈开
减压术
疗效
Lumbar spinal stenosis
Spinous process-splitting laminectomy
Decompression
Clinical results
