目的 探讨腰椎管狭窄症患者行后路椎管减压融合内固定术中的个体化椎管减压策略,并评价其疗效.方法 收集自2009年10月至2014年3月手术治疗的57例腰椎管狭窄症患者病历,其中男34例,女23例,年龄47～78岁,平均65.4岁.57例患者共77个节段,采用后路椎管减压、椎弓根钉棒系统固定、椎体间隙植骨融合手术治疗,其中采用单侧经椎间孔或经椎管椎体间隙撑开复位椎管减压26个节段,单侧椎板切除对侧椎板潜行切除椎管减压45个节段,改良全椎板切除椎管减压6例.术后3个月、12个月,根据日本骨科学会(Japanese Orthopaedic Association,JOA)评分标准和Os-westry功能障碍评分进行功能评价,测量CT扫描手术前后病变节段椎管前后径和椎管面积.结果 57例均获得随访,随访时间13～45个月,平均25.0个月的随访.1例术后出现暂时性神经功能障碍.JOA评分由术前的(13.52±4.48)分,改善为术后3个月的(22.50±2.38)分,术后12个月为(24.62±5.62)分;Oswestry功能障碍评分由术前的(31.52±4.64)分,改善为术后3个月的(16.55±4.48)分,术后12个月为(11.84±3.85)分,以上两个指标的差异均有统计学意义.椎管前后径和椎管面积分别由术前的(1.08±0.38) cm和(0.36±0.12) cm2扩大至术后的(2.07±0.74) cm和(2.23±0.95) cm2.单侧减压组椎管前后径从术前的(1.10±0.41)mm增至术后(2.10±0.84) mm,椎管面积术前(0.38±0.11)mm2增至术后(2.33±0.82) mm2;在潜行减压组和改良全椎板切除组也相似,术后的椎管前后径和椎管面积均较术前有扩大.各组内术前和术后比较的差异均有统计学意义.结论 对腰椎管狭窄症的实行个体化手术减压策略能有效扩大椎管,改善临床症状,并能有效保护椎管周围的骨组织和软组织.%Objective To discuss and evaluate the clinical outcome of the personal posterior decompression strategy for patients with lumbar spinal stenosis and underwent interbody fusion.Methods From October 2009 to March 2014,there were 57 patients with 77 vertebraes,34 male,24 femal,age from 47-78 years,with the average of 65.4 years.All were treated by decompression and interbody fusion via posterior approach.26 vertebra were underwent transforaminal intervertebral retracting decompression,45 vertebras were underwent one side laminectomy and another side undermined laminectomy,6 vertebras were underwent modified extensive lamina decompression.Patients were followed up 3 and 12months after operation and evaluated by Japanese Orthopaedic Association Score and Oswestry disability index,and anteroposterior diameter and cross-section area of spinal canal were measured by CT scan.Results All patients were followed up from 13-45 months with an average of 25.0 months.57 cases felt better after surgery.JOA score was from (13.52±4.48) points before surgery to (22.50±2.38) points 3 months after surgery,and (24.62±5.62) points 12 months after surgery.Oswestry score was from (31.52±4.64) points before surgery to (16.55±4.48) points 3 months after surgery,and (11.84±3.85) points 12 months after surgery.Anteroposterior diameter and cross-section area of spinal canal were from (1.08±0.38) cm and (0.36±0.12) cm2 before surgery to (2.07±0.74) cm and (2.23±0.95) cm2 after surgery.In transforaminal intervertebral retracting decompression group,anteroposterior diameter of spinal canal increased from (1.10 ± 0.41) mm before surgery to (2.10±0.84) mm after surgery,and cross-section area of spinal canal was also increased from (0.38± 0.11) mm2 to (2.33±0.82) mm2 after surgery.All of anteroposterior diameter and cross-section area of spinal canal in undermined laminectomy group and modified extensive lamina decompression group increased.Conclusion Personal posterior decompression strategy can expand lumbar canal effectively,improve symptom and protect bone and soft tissue near the canal.
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