目的：探讨痛风病变所致腰椎管狭窄症的诊断及治疗方法。方法对7例经保守治疗无效、术中及病理证实为痛风性椎管狭窄症的患者行后路椎板开窗减压、椎管神经根管扩大及神经根松解、椎弓根固定椎间植骨融合术。对患者临床表现、手术前后血尿酸水平、影像学特征及手术预后进行分析。结果7例患者术前均存在不同程度的腰腿痛及神经根性间隙性跛行,伴或不伴全身其他部位痛风病变及疼痛,血尿酸高低不一,CT检查可见关节突增生破坏,伴或不伴黄韧带钙化,椎管骨性狭窄。术中见关节突关节囊及黄韧带尿酸盐结晶沉着,关节突增生及骨质破坏,椎管显著狭窄。患者均获得随访,时间6~55个月。随访期间患者腰腿痛均消失,Barthel指数及VAS评分较术前显著好转,差异有统计学意义( P<0．05)；血尿酸无显著变化,术后无复发及并发症发生。结论痛风性腰椎管狭窄症的诊断主要是临床表现与影像学结果相结合,对保守治疗无效的患者手术治疗效果良好。%Objective To investigate the diagnosis and treatment of gouty lumbar spinal stenosis. Methods Seven cases of patients with gouty spinal stenosis confirmed by the operation and pathology were treated by posterior decom-pression, nerve root canal expansion and nerve root release, and the pedicle screw fixation and interbody fusion. The clinical manifestations, serum uric acid, imaging evaluation and surgical treatment were collected and analyzed. Re-sults All of 7 patients were found with lumbocrural pain and nerve root intermittent claudication, with or without gout disease and pain in other parts of the body, blood uric acid was high or low. CT examination showed the destruc-tion of the articular process, with or without calcification of the yellow ligament and vertebral canal stenosis. During the operation, the uric acid salt crystal was found deposition in the joint capsule and the yellow ligament, the joint and the bone were destroyed and the spinal canal was stenosis. All patients were followed up for 6~55 months. VAS and Barthel index significantly improved compared with the preoperation(P<0. 05). Blood uric acid had no signifi-cant change. All the pain disappeared, no recurrence and other complications occurred. Conclusions Diagnosis of gouty lumbar spinal stenosis is mainly based on the combination of clinical manifestation and imaging, surgical treat-ment effect is good for invalid conservative treatment.
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