微创神经根减压治疗腰椎管狭窄症的中远期疗效分析  

Medium to long-term efficacy analysis of minimally invasive nerve root decompression in the treatment of lumbar spinal stenosis

作　　者：刘通[1] 刘辉[1] 张建宁[1] 朱涛[1] 

机构地区：[1]天津医科大学总医院神经外科,300052

出　　处：《中华神经外科杂志》2017年第2期119-123,共5页Chinese Journal of Neurosurgery

摘　　要：目的 探讨微创神经根减压手术对腰椎管狭窄症的中远期治疗效果.方法 回顾性分析2008年1月至2014年12月天津医科大学总医院神经外科收治的208例腰椎管狭窄症患者的临床资料.208例均行显微神经根减压手术治疗,其中单节段单侧神经根减压121例,单节段双侧神经根减压34例,多节段单侧神经根减压31例,多节段双侧神经根减压22例.采用Oswestry功能障碍指数（ODI）评价临床疗效,并通过术后X线片评估术区上位相邻节段的椎间盘高度.随访时间为2～7年,平均（4.1±1.6）年.结果 208例患者中,182例完成随访,失访26例.对于单节段单侧、单节段双侧、多节段单侧以及多节段双侧腰椎管狭窄症患者,其术后不同时期腰椎ODI均较治疗前明显改善,差异均有统计学意义（均P＜0.05）.对于L1/L2、L2/L3、L3/L4、L4/L5腰椎管狭窄症患者,其术后不同时期上位相邻节段椎间盘高度与术前相比,差异均无统计学意义（均P＞0.05）.患者无一例出现硬脊膜损伤、神经根损伤及椎间隙感染.结论 采用精准显微神经根减压手术治疗腰椎管狭窄症创伤小、恢复快,可显著改善患者的神经根性症状,中远期可有效维持脊柱生物力学的稳定.Objective To explore the effects of minimally invasive nerve root decompression in the treatment of lumbar spinal stenosis.Methods From January 2008 to December 2014,208 patients with lumbar spinal stenosis received nerve root decomprcssion under microscope at Department of Neurosurgery,Tianjin Medical University General Hospital.Among them,single-level unilateral decompression was performed in 121 cases,single-level bilateral decompression in 34 cases,multiple-level unilateral decompression in 31 cases and multiple-level bilateral decompression in 22 cases.The Oswestry disability index （ODI） and disc height of upper adjacent segment were documented.The follow-up lasted 2 ～ 7 years （mean,4.1 years）.Results Out of 208 patients,182 were successfully followed up and 26 were lost to follow-up.Based on the ODI,significant functional improvement was observed during follow-up at different time points （P 〈 0.05） for patients with single-/multiple-level and unilateral/bilateral lumbar spinal stenosis.Compared with preoperative valucs,there was no statistical significance in disc height at different time points of follow-up （P 〉 0.05） for patients with Lt/L2,L2/L3,L3/L4,L4/L5 stenosis.Conclusions With limited trauma and fast recovery,microscopic nerve root decompression seems effective for symptom relief of lumbar spinal stenosis and helpful in maintaining spinal biomechanical stability.

关 键 词：椎管狭窄 腰椎 减压术 外科 外科手术 微创性 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]