显微减压术治疗多平面腰椎管狭窄症

摘要

Objective:To summarize the clinical application results of the micro-decompression procedure for the treatment of lumbar spinal stenosis with multilevel. Methods: From January 2004 to December 2008,40 patients with lumbar spinal stenosis with multilevel were treated by micro-decompression procedure. There were 28 males and 12 females,ranging in ages from 55 to 80 years,with an average of 58 years. The course of this disease ranged from 18 months to 12 years,averaged 32 months. Forty patients with lumbar spinal stenosis with multilevel were diagnosed by CT or MRI examination. There were 20 cases with two levels stenosis (L,.5and L5S1) ,15 cases with three levels stenosis (13,4,14,5 and L5S1) ,and 5 cases with four levels stenosis (L2,3,L3,4,L4,5 and L5S1). The therapeutic effects were evaluated according MacNab standard in aspect of pain, bladder function, range of lumbar spine motion and muscle strength of lower limb. Results: All of the incisions healed without infections and complications. The mean operation time of each side was 70 minutes (ranged from 50 to 90 minutes) ,and mean blood loss was 150 ml (ranged from 90 to 200ml). All the patients were followed up from 22 to 52 months with an average of 26 months. According to MacNab standard,28 cases got an excellent result, 10 good and 2 poor. Conclusion:Operative treatment for lumbar spinal stenosis with multilevel should focus on the symptom sites causing by neural compression and preventive decompression operations are not necessary for nonsymptomatic sites. The micro-decompression procedure can be easily tolerated by older patients;it can decrease the damage to the posterior stabilizing structures of the lumbar spine. It is easily to access to spinal canal and decompress the nerve roots.%目的:总结显微减压术治疗多平面腰椎管狭窄症的临床应用结果.方法:2004年1月至2008年12月,对40例多平面腰椎管狭窄症患者采用显微减压术治疗,其中男28例,女12例;年龄55～80岁,平均58岁;病程18个月～12年,平均32个月.40例均经CT或 MRI检查诊断为多平面腰椎管狭窄,其中2个平面狭窄(L4,5和L5S1)20例,3个平面狭窄(L3,4、L4,5和L5S1)15例,4个平面狭窄(L2,3、L4,5 和L5S1)5例.术后根据MacNab疗效评定标准,从疼痛、排尿功能障碍、腰部活动度、下肢肌力等方面对疗效进行评定.结果:40例患者术后无伤口感染及神经损伤并发症,伤口均Ⅰ期愈合.每侧手术时间50～90 min,平均70 min;每侧术中出血量90～200 ml,平均150 ml.所有病例均获随访,随访时间22～52个月,平均30个月.根据MacNab标准对疗效进行评定:优28例,良10例,差2例.结论:对腰椎管狭窄症的手术治疗重点应放在压迫引起症状的部位,而对无症状的部位不做预防性减压操作.显微减压术老年人更容易耐受,减轻了对腰椎后部结构的损伤,更容易进入椎管,有利于进行神经根减压.