腰椎棘突劈开椎管减压术治疗退变性腰椎管狭窄症

Lumbar spinous process-splitting laminectomy for lumbar spinal canal stenosis

中文关键词:  腰椎管狭窄症  棘突劈开  减压术  疗效

英文关键词:Lumbar spinal stenosis  Spinous process-splitting laminectomy  Decompression  Clinical results

中文摘要:

  【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。

英文摘要:

  【Abstract】 Objective：To investigate the clinical outcome of lumbar spinous process-splitting laminectomy 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 duration 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 cases，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）.All patients underwent lumbar spinous process-splitting laminectomy.The mean pre-operative 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 and 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±2.1min respectively.Three days after surgery，the CPK was 336±16.1u/l.27 cases except 1 case 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 multifidus muscle atrophy was noted.Conclusion：Lumbar spinous process-splitting laminectomy can effectively protect bilateral multifidus and decrease the occurrence of postoperative low back pain，which is effective for managing lumbar spinal stenosis.