后路腰椎间融合治疗腰椎管狭窄症患者腰痛疗效分析.docVIP

后路腰椎间融合治疗腰椎管狭窄症患者腰痛疗效分析 　 作者：王波　刘海鹰　王会民　缪克难　金朝晖 【摘要】 ［目的］分析腰椎管狭窄症患者腰痛的原因，探讨后路腰椎间融合术对腰椎管狭窄症腰痛的治疗效果。［方法］比较腰痛明显的腰椎管狭窄症患者和典型间歇性跛行症状的腰椎管狭窄症患者的年龄、术前腰椎失稳、生理前凸消失和退变性侧弯的发生率；分析后路腰椎间融合 (posterior lumbar interbody fusion, PLIF) 治疗腰椎管狭窄症患者下腰痛的随访结果。［结果］腰痛明显组的腰椎管狭窄症患者的平均年龄、腰椎节段性失稳率、腰椎前凸消失和退变性侧弯的比率高于间歇性跛行组的腰椎管狭窄症患者。PLIF术后腰痛症状明显减轻，JOA评分改善，退变性侧弯程度减轻，腰椎前凸恢复，椎间均达到骨性融合。［结论］PLIF可消除腰椎管狭窄症的多种腰痛病因，是治疗腰椎管狭窄症下腰痛的较好术式选择。 【关键词】 后路腰椎间融合　腰椎管狭窄症　下腰痛 　 Abstract: ［Objective］To analyze the causes of back pain in lumbar spinal stenosis and to investigate the therapeutic effect of posterior lumbar interbody fusion (PLIF) for lumbar stenosis with severe back pain. ［Methods］The preoperative clinical data on patients with lumbar stenosis and severe back pain were compared with those of patients with typical neurological claudication. The follow-up results of lumbar stenosis with severe low back pain treated by PLIF were analyzed.［Results］The average age and the rates of segmental instability, degenerative scoliosis, loss of lumbar lordosis in patients with lumbar stenosis and severe back pain were higher than those with lumbar stenosis and typical claudication. After PLIF surgery, the back pain was much relieved, the JOA score was improved, the severity of degenerative scoliosis was reduced, and the lumbar lordosis was restored. Bony fusion was achieved in all operated intervertebral spaces.［Conclusion］PLIF could eliminate various causes due to back pain of lumbar stenosis. PLIF is one of reasonable treatment options for lumbar stenosis with severe low back pain. 　 Key words：posterior lumbar interbody fusion (PLIF); low back pain; lumbar stenosis 　　腰椎管狭窄症多见于中老年患者，典型临床表现为神经源性间歇性跛行，椎管和侧隐窝减压常可有效缓解下肢症状。但部分腰椎管狭窄症患者以腰痛为主要症状，腰痛程度重于下肢疼痛的程度。腰痛的病因复杂，单纯椎管减压术常常效果不佳。本科2004年1月～2006年6月采用后路腰椎间融合(posterior lumbar interbody fusion, PLIF)为主综合治疗腰痛明显的腰椎管狭窄症106例，同期收治的以间歇性跛行为主要症状的腰椎管狭窄症341例，比较两者术前临床资料，分析腰痛原因，随访观察PLIF治疗腰椎管狭窄症腰痛的疗效，报告如下。 　 1 资料与方法 　　1.1 一般资料 2004年1月～2006年6月本科收治腰椎管狭窄症患者447例，其中以腰痛为主要症状者（腰痛组）106例，男41例，女65例；年龄53～