长节段减压短节段融合治疗多节段退行性腰椎管狭窄症

Multilevel decompression combined with selected fusion in the treatment for multilevel lumbar stenosis

中文关键词:  腰椎管狭窄症  多节段  退行性  长节段减压  短节段内固定  融合

英文关键词:Lumbar stenosis  Multilevel  Decompression  Selected fusion

中文摘要:

  【摘要】 目的：探讨长节段减压短节段融合治疗多节段退行性腰椎疾患的临床疗效。方法：2002年5月～2008年1月采取长节段减压短节段融合的方法治疗多节段腰椎管狭窄症患者27例，男15例，女12例；年龄51～80岁，平均67.3岁。术前根据患者临床表现及影像学特点确定减压及融合节段，均在充分减压的基础上选择性融合，使融合节段少于减压节段。对于术前计划保留活动度的节段仅行单侧或双侧椎板间开窗减压。临床疗效采用JOA、VAS及ODI评估方法评定。随访拍摄腰椎动态X线片及腰椎MRI，观察单纯减压未行融合节段腰椎稳定性及融合相邻节段退变情况。结果：27例患者共减压56个节段，固定29个节段。随访14～84个月，平均38个月，末次随访时，临床功能JOA评分由术前11.4±2.8分提高到21.1±4.4分（P<0.01）；ODI评分由术前平均65.0%±22.1%改善至23.0%±10.7%（P<0.01）；腰痛VAS评分由术前6.0±2.3分改善至2.3±1.8分（P<0.01），腿痛VAS评分由术前7.9±1.6分改善至2.9±2.2分（P<0.01）。27例患者中26例对术后疗效满意。动态X线片检查未融合节段无医源性失稳；MRI复查未见需再次手术干预的相邻节段退变。结论：应用长节段减压短节段融合治疗多节段退行性腰椎管狭窄症可取得良好临床效果，在保留更多运动节段的同时未影响腰椎稳定性。

英文摘要:

  【Abstract】 Objective：To investigate the therapeutic effects of multilevel decompression combined with selected fusion in the treatment for multilevel lumbar stenosis.Method：27 cases of multilevel lumbar stenosis treated with long segmental decompression and selected fusion were reviewed retrospectively.The involved segments were determined by symptoms，clinical features and radiographic documents.The decompression on the stenosed nerve roots and selected fusion on the segments with preoperative instability and probably iatrogenic unstable levels were carried out.The patients were assessed clinically with the Japanese Orthopedic Association（JOA） score，visual analog scale（VAS） and Oswestry Disability Index（ODI）.The dynamic X ray and MRI were used to evaluate the lumbar stability and adjacent segment degeneration.Result：Decompression of 56 segments and fusion of 29 segments were performed on the 27 patients.The mean follow-up period was 38 months（ranges 14-84 months）.The average JOA score was 11.4±2.8 points at the initial examination and 21.1±4.4 points at the final follow-up（P<0.05）.The average ODI score for the 27 patients was 65.0%±22.1% preoperatively，and it decreased to 23.0%±10.7%（P<0.01） at follow-up.The average VAS score of low back pain and leg pain was 6.0±2.3 and 7.9±1.6 respectively before surgery，which decreased to 2.3±1.8 and 2.9±2.2 at follow-up.26 of 27 patients were satisfied with the outcome.MRI examination revealed no significant changes and disability at adjacent level.Conclusion：This investigation suggests that the clinical outcomes of multilevel decompression with selected fusion for multilevel lumbar stenosis show good results by individual surgical plan on the basis of careful evaluation of clinical and radiological features.