腰椎间孔狭窄症的诊断与手术治疗  

Diagnosis and Operative Treatment of Lumbar Foraminal Stenosis

作　　者：王培增 苏炜 桑仲亮 郭少华 

机构地区：[1]山东省青州市401医院青州分院外科

出　　处：《实用骨科杂志》1999年第1期5-7,共3页Journal of Practical Orthopaedics

摘　　要：目的：讨论腰椎间孔狭窄症的病理解剖、临床特征、诊断和手术治疗。方法：对１９９１年至１９９８年间４２例腰椎间孔狭窄症病人的诊断与手术治疗进行了回顾性研究。结果：术后对其中的３８例病人进行了０．５～５．５年，平均３．５年的随访，手术优良率达９２．７％。结论：引起腰椎间孔狭窄并导致根本性卡压征的原因有腰椎间盘退变狭窄，小关节增生内聚，黄韧带肥厚内陷，椎间孔内间盘突出和腰椎滑脱等。诊断依赖于根性损害表现和可靠的腰椎ＣＴ扫描或ＭＲＩ检查。手术包括腰椎间孔的探查和减压，术中注意保护和重建脊柱稳定性，并防止神经结构误伤。Purpose:To analyze the pathoanatomy,diagnosis,clinical features and surgical treatment of the lumbar foraminal stenosis.Method:Forty-two patients of lumbar foraminal stenosis were diagnosed and operated from January 1991 to January 1998.Results:Thirty-eight of the 42 cases were followed up from 0.5 year to 5.5 years(average 3.5 years) postoperatively.The excellent and good rates were 92.7%.Conclusion:A decrease in the height of an lumbar disc,osteoarthritic changes in the facet joints,subluxation of the facet joints,buckling of the ligamentum flavum,and lumbar disc herniation in the lumbar foramen or lumbar vertebral spondylolisthesis all may give rise to lumbar froaminal stenosis so that the lumbar spinal nerve root may be entrapped or comppressed.The clinical manefestations of the disease present radiculopathical symptoms and signs. The diagnosis of the disease mainly depend on the clinical findings,CT and MRI.The surgical treatments include exploration and decompresison of the marrowed lumbar for Treatmentamen or the lumbar spinal canal.The lumbar stability should be protected by laminal fenestratinos and partial facetectomy,otherwise the spinal stability should be reconstructed with the intertransverse process fusion.The injury of the lumbar nerve root or dorsal nerve root ganglion should be avioded during the operation.

关 键 词：诊断 腰椎 椎间孔狭窄 手术治疗 病人 脊柱稳定性 神经结构 误伤 MRI检查 黄韧带肥厚 

分 类 号：R681[医药卫生—骨科学] R683[医药卫生—外科学]