显微镜下椎板开窗减压术治疗腰椎椎管狭窄  

Laminectomy decompression under microscope for lumbar spinal stenosis

作　　者：彭仁君[1] 黄鹤[1] 丁锡平[1] 姜冰[1] 袁贤瑞[1] 奚健[1] 

机构地区：[1]中南大学湘雅医院神经外科,长沙410008

出　　处：《中华神经外科杂志》2016年第12期1225-1228,共4页Chinese Journal of Neurosurgery

基　　金：基金项目：湖南省科技厅课题（2012FJ6075）

摘　　要：目的探讨显微镜下椎板开窗减压术治疗腰椎椎管狭窄的临床疗效。方法回顾性分析中南大学湘雅医院神经外科2015年4月至2016年4月对13例腰椎椎管狭窄患者施行显微镜下患侧或双侧椎板开窗减压术。其中单个节段狭窄8例，2个节段狭窄3例，3个节段狭窄2例。手术节段：L2-3 2个，L3-4 5个，L4-5 10个，L5-S1 3个。术前、后均采用疼痛视觉模拟评分量表（VAS）对患者的疼痛缓解情况进行评估。术后定期随访，复查MRI、CT和腰椎X线动力位。结果本组患者手术时间为1．5-5．5h，术中失血量为50~400ml，术后住院时间为8～21d。13例患者术后腰腿疼痛均较术前明显改善，VAS评分由术前的（4．23±0．79）分降至术后的（1．38±0．62）分，无神经损伤及硬脊膜撕裂所致脑脊液漏的发生。术后无心脑血管并发症发生。术后1例出现胸部带状疱疹，1例出现股外侧皮神经炎。1例术前存在大小便障碍的患者术后开始恢复，术后第10天可自行排出小便。9例下肢麻木的患者术后均有不同程度的减轻。本组术后随访1-12个月，未见脊柱畸形和脊柱失稳症加重的患者。结论显微镜下椎板开窗减压术治疗腰椎管狭窄具有手术时间短、术中失血量少、住院时间短的优势，能获得充分的减压及良好的临床效果，但手术对腰椎稳定性的长期变化有待于进一步观察。Objective To investigate the efficacy of laminectomy decompression under microscope for lumbar spinal stenosis. Methods A retrospective study was conducted regarding 13 patients with lumbar spinal stenosis who were admitted to Depamr, ent of Neurosurgery, Xiangya Hospital, Central South University, from April 2015 to April 2016 and underwent unilateral/bilateral laminectomy decompression under microscope. Among the 13 patients of lumbar stenosis, 8 cases involved single segment, 3 invovled 2 segments and 2 involved 3 segments. The segments operated on were L2-3 in 2 cases, L3-4 in 5 cases ,L4-5 in 10 cases and L5 -S1 in 3 cases. The preoperative and postoperative Visual Analogue Scale （VAS） scores were used to evaluate the pain relief. Postoperative follow-up on a regular basis was conducted including examinations of magnetic resonance imaging （MRI）, computed tomography （CT） and dynamic spine X-ray. Results Tne operation time in this group was 1.5 -5.5 h , the intraoperative blood loss measured 50 -400 ml, and postoperative hospital stay was 8 - 21 d. Back and leg pain in all patients were signiticanfly improved after operation. The postoperative VAS score was 1.38 and decreased from preoperative 4.23. No nerve injury or cerebrospinal fluid leakage due to spinal dura tears was observed in this study. No cardiac or cerebrovascular complicatious occurred after surgery. Postoper-atively, chest herpes zoster in 1 case and lateral femoral cutaneous neuritis in 1 case were observed. One patient with preoperative bowel and bladder disorders began to recover after opeartion,and restored independent urination 10 days post operation. Varying degrees of ease of lower limb numbness was reported in 9 cases. Condusions Laminectomy decompression under microscope for lumbar spinal stenosis demonstrated advantages including shorter operation time, less intmoperative blood loss and shorter hospitalization length, through which sufficient decompression and good clinical outcomes could be obtained. Further observation is

关 键 词：椎管狭窄 显微外科手术 减压术 外科 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]