退变性腰椎管狭窄症手术治疗.docVIP

退变性腰椎管狭窄症手术治疗【摘要】 目的 探讨退变性腰椎管狭窄症手术治疗的疗效及其手术适应证。方法 回顾性分析2004年1月至2009年8月手术治疗65例退变性腰椎管狭窄症患者,男36例,女29例。平均年龄60.5岁。应用日本骨科学会(JOA)下腰痛手术疗效标准(29分法),对患者进行术前术后评分,计算改善率。结果 65例获2~5年随访,平均2年8个月,术后优良率为83.6%。结论 老年人腰椎管狭窄症经正规保守治疗无效后应积极手术治疗,根据患者病情和影像学表现,仔细分析确定责任节段和责任因素,选择合适的手术方式,围手术期正确处理,能减少并发症,提高手术疗效。 【关键词】 老年人;退变性;腰椎; 椎管狭窄;治疗结果 Surgery treatment of degenerative lumbar canal stenosis ZHANG Qing-lin,FENG Cai-yan,LI Jiang,et al.Department of Orthopedics,Qiaotou Hospital of Dongguan City,Guangdong Dongguan 523538,China 【Abstract】 Objective To look into the effect of surgery treatment for the patients with degenerative lumbar canal stenosis(LCS)and the indication for the surgery.Methods 65 senile patients(more than 55 years old)with degenerative lumbar canal stenosis who underwent surgical treatment from Jan 2004 to Aug 2009 were analyzed retrospectively.There were 36 males and 29 females in this study and the average age was 60.5 years old.We evaluated all the patients by the Japan Orthopedic Association(JOA)Scoring System for low back pain(LBP)(29 points)pre and post operation concluding the improvement rate.Results The 65 patients were followed up for 2 to 5 years,with average of 2 years and 8 months.The improvement rate of post operation was 83.6%.Conclusion Operations should be used for the patients with senile lumbar canal stenosis who didn’t respond to the formal conservative treatment.The surgical modality should be chose after carefully analyzing the responsible segments and factors according to the disease history,radiographic manifestation.Proper management in perioperative stage can induce the complication and improve the surgical results. 【Key words】 Senile;Degeneration;Lumbar spine;Spinal canal stenosis;Therapeutic result 任何原因引起的椎管、神经根管、椎间孔任何形式的狭窄并导致神经根和(或)马尾压迫综合征,均统称为腰椎管狭窄症。老年退行性腰椎管狭窄临床很常见,病情持续时间较长,临床表现和病理复杂。老年人全身体质的有其特殊性,对活动要求的下降及腰椎的代偿性再稳定等特点的不同及每个人个体差异的不同,决定了手术方法的选择与青壮年的不同。尽管在腰椎管狭窄症分类上存在不少争议,在具体治疗的选择上也存有异议,然而对外科手术治疗的效果和地位仍存在一定共识。与腰椎间盘突出症相比,腰椎管狭窄症的非手术治疗