多节段腰椎管狭窄症外科手术治疗的功能评价_临床医学论文.docVIP

多节段腰椎管狭窄症外科手术治疗的功能评价_临床医学论文 多节段腰椎管狭窄症外科手术治疗的功能评价_临床医学论文 【摘要】 本文通过对56例多节段腰椎管狭窄症患者的回顾性研究，探讨多节段腰椎管狭窄的发病特征、手术治疗方法及术后疗效评价。［方法］1998～2002年,56例多节段腰椎管狭窄病人,术前常规行临床神经功能检查，影像学检查包括标准的腰椎正侧位、左右斜位及前屈、后伸动力位X线片、腰椎CT及MRI检查。手术前后应用Beaujon功能评分法，Oswestry disability index(ODI)及visual analog scale (VAS)进行主客观评估。手术方法采用受累节段广泛椎板减压，椎弓根钉系统固定，后外侧植骨融合术式。［结果］经过平均2.2年的随访, 病人在临床上Beaujon 评分有提高 (0.05),ODI 和VAS评分有显著性差异。［结论］广泛椎板减压，椎弓根钉系统固定，后外侧植骨融合术是治疗多节段腰椎管狭窄的有效手段，只要准确地选取减压脊柱节段，该术式可以得到良好和持久的临床结果。 【关键词】 多节段 腰椎管狭窄症 外科治疗 Abstract: ［Objective］To evaluate the clinical and radiological findings in 56 patients with multilevel lumbar spinal stenosis in pre- and post- surgical treatment. ［Method］From 1998 and 2002, 56 patients suffering from multilevel lumbar spinal stenosis were included in a retrospective clinical study. Plain radiographs, MRI and/or CT myelograms were obtained preoperatively. The patients were assessed clinically with Oswestry disability index (ODI),visual analog scale (VAS) and the Beaujon functional score. Surgical procedure included wide posterior decompression and fusion using a transpedicular instrumentation system and bone grafts. ［Result］After a mean follow-up of 2.2 (2～2.6) years, the patients’ clinical improvement by ODI,VAS was statistically significant and the Beaujon score was significantly improved (0.05). ［Conclusion］This technique gives good and long lasting clinical effectiveness when the candidate patients are carefully selected and the spinal levels to be decompressed are accurately determined. Key words：multilevel; lumbar spinal stenosis; surgical treatment; functional evaluation 本院自1998～2002年共治疗多节段退变性椎管狭窄（2个以上脊柱节段）患者56例,均采用受累节段的广泛椎板减压，椎弓根钉系统固定，后外侧植骨融合术治疗。手术前后应用Beaujon功能评分法，Oswestry disability index (ODI)及Visual analog scale (VAS)进行主客观评估。现将功能评价结果总结如下。 1 资料与方法 1.1 一般资料 本组56例患者，男22例，女34例；平均62岁（42～78岁）， 均患有多节段腰椎管狭窄症。治疗方法为受累节段的广泛椎板减压，椎弓根钉系统固定，后外侧植骨融合术。其中腰椎间盘突出合并多节段椎管狭窄17例 ,骨质增生性多节段椎管狭窄16例,多节段失稳性椎管狭窄12例,脊柱侧凸合并多节段椎管狭窄9例,多节段发育性椎管狭窄2例。 1.2 主要临床症状、体征 患者均有不同程度的下腰痛，双下肢酸胀、麻木及疼痛感