腰椎退变性侧弯伴椎管狭窄的外科治疗

摘要

目的 探讨退变性脊柱侧弯伴椎管狭窄的特点、手术减压范围及其临床效果;方法 32例腰椎退变性侧弯伴椎管狭窄患者,5例行椎板间开窗侧隐窝扩大减压(A组),19例行全椎板切除减压椎弓根螺钉内固定椎间融合术(B组),8例行全椎板减压并神经根管扩大减压椎弓根螺钉内固定椎间融合术.对所有术前术后影像学特点、减压方式、减压范围和功能评分(症状、体征)进行比较和评估.结果 A组中5例行开窗减压患者中3例效果良好,1例有好转但仍有症状,1例术后症状无明显减轻;B组中16例效果良好,2例症状缓解不完全,1例出现马尾神经损伤症状;C组中8例效果良好.结论 退变性脊柱侧弯伴椎管狭窄病变较复杂,手术方案要根据椎管狭窄的程度、范围和侧弯的类型确定,外科治疗的主要目的 是神经减压和最大限度最大可能的稳定和重排脊柱.对单纯侧隐窝狭窄而中央椎管不狭窄者可选择椎板间开窗减压,但这种减压范围往往不能达到完全减压,部分患者会残留狭窄症状,对合并中央椎管和侧隐窝同时狭窄者要采用双侧全椎板减压,部分出现神经根管狭窄者要对狭窄的神经根管进行减压和扩大或者通过纠正侧弯和旋转改善狭窄的神经根管和改善神经根牵拉紧张状况.u0000状缓解不完全,1例出现马尾神经损伤症状u0000C组中8例效果良好.结论 退变性脊柱侧弯伴椎管狭窄病变较复杂,手术方案要根据椎管狭窄的程度、范围和侧弯的类型确定,外科治疗的主要目的 是神经减压和最大限度最大可能的稳定和重排脊柱.对单纯侧隐窝狭窄而中央椎管不狭窄者可选择椎板间开窗减压,但这种减压范围往往不能达到完全减压,部分患者会残留狭窄症状,对合并中央椎管和侧隐窝同时狭窄者要采用双侧全椎板减压,部分出现神经根管狭窄者要对狭窄的神经根管进行减压和扩大或者通过纠正侧弯和旋转改善狭窄的神经根管和改善神经根牵拉紧张状况.u0000状缓解不完全,1例出现马尾神经损伤症状u0000C组中8例效果良好.结论 退变性脊柱侧弯伴椎管狭窄病变较复杂,手术方案要根据椎管狭窄的程度、范围和侧弯的类型确定,外科治疗的主要目的 是神经减压和最大限度最大可能的稳定和重排脊柱.对单纯侧隐窝狭窄而中央椎管不狭窄者可选择椎板间开窗减压,但这种减压范围往往不能达到完全减压,部分患者会残留狭窄症状,对合并中央椎管和侧隐窝同时狭窄%Objective To investigate the specific scope of surgical decompress and result of de-generative lumbar stenosis with scoliosis (DLSS). Methods The cases of degenerative lumbar stenosis with scoliosis (DLSS) 32 were review,5 cases of them underwent posterior lumbar window laminectomy and recess enlarge (Group A), 19 cases of them underwent posterior lumbar laminecto-my interbody fusion with pedicle screw fixation(Group B);8 cases of them underwent posterior lum-bar laminectomy and nerve root tubule decompress and interbody fusion with pediele screw fixation (Group B);The pre- and post-operation image,decompress manner and scope,function grade were observed. Results 3 of 5 cases the result of surgery were good in group A,16 of 18 cases the result of surgery were good in group B,but one case cauda equina was injuried,all cases were good in group C. Conclusion The pathological changes of degenerative lumbar stenosis with scolio-sis is complexity,we must according as the extent of stenosis and scoliosis type confirm the project of operation,the purpose of surgery is decompress,recomposition and stabilization lumbar.