复杂性腰椎管狭窄症的外科治疗_临床医学论文.docVIP

复杂性腰椎管狭窄症的外科治疗_临床医学论文 复杂性腰椎管狭窄症的外科治疗_临床医学论文 作者：郝定均，贺宝荣，郭 华，宋宗让，吴起宁，刘团江 【摘要】 [目的]探讨复杂性腰椎管狭窄症的手术方法。[方法]回顾性分析1997年1月～2001年1月采用后路减压、植骨融合、椎弓根螺钉系统内固定治疗复杂性腰椎管狭窄症176例,男98例，女78例;平均年龄58.5岁。病史2～31年。既往腰椎有1次手术史者35例，2次或2次以上者19例，合并退变性Ⅰ度以上滑脱40例，合并腰椎侧凸，Cobb’s角大于20° 42例，术后伴有腰椎不稳21例，术后交界处椎管狭窄19例。术中对一个或两个节段者切除椎间盘，处理相邻椎板，行椎间植骨融合，部分保留小关节突者同时行小关节融合;两个节段以上者对不需要切除椎间盘或者切除小关节突小于1/2者行小关节突加横突间融合,切除椎间盘者行椎间融合;合并腰椎侧凸者对狭窄部位先行后方减压，植入椎弓根螺钉，安装连接棒，应用旋棒，结合压缩、撑开技术矫正侧凸，对椎间盘突出较重的间隙行椎间融合加小关节突融合，其余节段行后外侧融合。[结果]手术时间80～250 min，术中出血450～1 600 ml，无围手术期死亡。术后平均随访5.6年，JOA评定以改善率表示,椎间融合优良率87.4%，多间隙优良率为86.1%，合并腰椎侧凸者优良率为89.8%。合并腰椎侧凸Cobb’s角平均6.7°，矫正率73.8%。腰椎后外侧融合率92%(60/65),椎间融合组为97.9%(139/142)。[结论]复杂性腰椎管狭窄症手术难度大，风险高。后路椎管减压、植骨融合、经椎弓根螺钉系统内固定是一种较好的治疗方法。 【关键词】 腰椎管狭窄; 脊柱滑脱; 脊柱侧凸; 手术治疗 　　Abstract: [Objective]To investigate the methods of surgical treatment of complicated lumbar spinal stenosis. [Methods]Totally 176 patients who were diagnosed as having complicated lumbar spinal stenosis, operated by back decompression, fused by bone graft and internal fixed by pedicle screws from January 1997 to January 2001 were retrospectively analyzed. Ninety-eight were males and 78 were females,with an average age of 58.5 years. Patient history was from 2 to 31 years. Thirty-five patients had a previous surgery on lumbar vertebrae,and 19 patients had two or more. Forty patients were complicated with one degree degenerated olisthe, 42 were complicated with lumbar scoliosis and Cobb’s angle more than 20°,21 had lumbar unsteadiness after surgery,19 patients had spinal stenosis in juncture after surgery.One ore two segments intervertebral discs were removed and vertebral plate were closed together, fused by bone graft and fused articular process.To the patients with more than two segments affection, processus articularis and processus transverses were fused to the patients need not remove intervertebral disk or remove less than half of processus articularis and interbody vertebral were fused to the patient need remove intervertebral disk.Pat