选择性开窗潜行减压治疗退行性腰椎管狭窄症
作者：周根欣 章进 祝健 倪增良
单位：兰溪市第二医院，浙江 兰溪 321100
关键词：椎管狭窄；外科手术；减压
中国骨伤000909摘 要：目的探讨退行性腰椎管狭窄治疗的手术方式，讨论本病的病理特点和采用选择性开窗潜行减压这一术式的可行性。方法对63例退行性腰椎管狭窄症患者，根据其术前CT等的定位、定性、定量及术中的具体所见，针对性地选择一侧或双侧，单个或多个开窗，行潜行减压治疗，并观察其后期疗效。结果经治疗的63例患者，开窗潜行减压基本上达到了满意的减压效果，疗效达优27例，占42.8%；良33例，占52.4%；可3例，占4.5%；差0例。结论通过不同的开窗方式和多个开窗、有限的椎板及关节突切除、剥离和摘除退变增厚的黄韧带和椎间盘、潜行扩大椎管，能达到充分减压及尽量保留腰椎后部结构的双重目的，保证腰椎的稳定性，避免医源性椎管狭窄及脊椎滑移的发生。
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Treatment of degenerative lumbar spinal canal stonosis with selective fenestration decompression
ZHOU Gen-xin ,ZHANG jin ,ZHU Jian
(The Second Hospital of Lanxi Zhejiang Lanxi, 321100)
Abstract：Objective To describe a surgical method for the treatment of degenerative lumbar canal stenosis, to study its pathologic features and to discuss the procudure of selective fenestration decompression. Methods 63 cases of degenerative lumbar canal stenosis were treated with one or double,single or multilevel widened fenestration decompression according to the location, nature and size of the stenosis shown in the preoperative CT examination and the intra-operative findings. The post-operative outcome were observed. Results All the patients obtained effective decompression following widened fenestration. The outcome was excellent in 27 cases (42.8%), good in 33 cases (52.4%), fair in 3 cases (4.5%)and poor in none. Conclusion The widened fenestration included different modes of fenestrations, minimal resection of vertebral laminal and articular process, stripping and extirpating of degenerative and hypertrophic ligamentum flava and intervertebral discs. It could maintain spinal stability with effective decompression and avoid iatrogenic lumbar canal stenosis and lumbar spondylolisthesis.
, 百拇医药
Keywords：Spinal stenosis Surgery, operative Decompression
参考文献：
[1]贾连顺，李家顺主编.现代腰椎外科学.上海：上海远东出版社，1995.123.
[2]戴力扬，徐印坎，张文明，等.人腰椎后部结构切除对腰椎抗压强度的影响.中华神经外科杂志，1989，5(2)：87.
[3]戴力扬，徐印坎，张文明，等.腰椎后部结构切除引起过度活动的实验研究.中华创伤杂志，1989，5(2)：85.
[4]戴力扬，徐印坎，张文明，等.后部结构切除对腰椎稳定性影响的生物力学研究.中华外科学杂志，1988，26(5)：272.
[5]马法杰，周秉文.退行性腰椎滑脱症的X线形态学观察.中国脊柱脊髓杂志，1993，3(1)：101.
收稿日期：1998-09-21, 百拇医药
单位：兰溪市第二医院，浙江 兰溪 321100
关键词：椎管狭窄；外科手术；减压
中国骨伤000909摘 要：目的探讨退行性腰椎管狭窄治疗的手术方式，讨论本病的病理特点和采用选择性开窗潜行减压这一术式的可行性。方法对63例退行性腰椎管狭窄症患者，根据其术前CT等的定位、定性、定量及术中的具体所见，针对性地选择一侧或双侧，单个或多个开窗，行潜行减压治疗，并观察其后期疗效。结果经治疗的63例患者，开窗潜行减压基本上达到了满意的减压效果，疗效达优27例，占42.8%；良33例，占52.4%；可3例，占4.5%；差0例。结论通过不同的开窗方式和多个开窗、有限的椎板及关节突切除、剥离和摘除退变增厚的黄韧带和椎间盘、潜行扩大椎管，能达到充分减压及尽量保留腰椎后部结构的双重目的，保证腰椎的稳定性，避免医源性椎管狭窄及脊椎滑移的发生。
, http://www.100md.com
Treatment of degenerative lumbar spinal canal stonosis with selective fenestration decompression
ZHOU Gen-xin ,ZHANG jin ,ZHU Jian
(The Second Hospital of Lanxi Zhejiang Lanxi, 321100)
Abstract：Objective To describe a surgical method for the treatment of degenerative lumbar canal stenosis, to study its pathologic features and to discuss the procudure of selective fenestration decompression. Methods 63 cases of degenerative lumbar canal stenosis were treated with one or double,single or multilevel widened fenestration decompression according to the location, nature and size of the stenosis shown in the preoperative CT examination and the intra-operative findings. The post-operative outcome were observed. Results All the patients obtained effective decompression following widened fenestration. The outcome was excellent in 27 cases (42.8%), good in 33 cases (52.4%), fair in 3 cases (4.5%)and poor in none. Conclusion The widened fenestration included different modes of fenestrations, minimal resection of vertebral laminal and articular process, stripping and extirpating of degenerative and hypertrophic ligamentum flava and intervertebral discs. It could maintain spinal stability with effective decompression and avoid iatrogenic lumbar canal stenosis and lumbar spondylolisthesis.
, 百拇医药
Keywords：Spinal stenosis Surgery, operative Decompression
参考文献：
[1]贾连顺，李家顺主编.现代腰椎外科学.上海：上海远东出版社，1995.123.
[2]戴力扬，徐印坎，张文明，等.人腰椎后部结构切除对腰椎抗压强度的影响.中华神经外科杂志，1989，5(2)：87.
[3]戴力扬，徐印坎，张文明，等.腰椎后部结构切除引起过度活动的实验研究.中华创伤杂志，1989，5(2)：85.
[4]戴力扬，徐印坎，张文明，等.后部结构切除对腰椎稳定性影响的生物力学研究.中华外科学杂志，1988，26(5)：272.
[5]马法杰，周秉文.退行性腰椎滑脱症的X线形态学观察.中国脊柱脊髓杂志，1993，3(1)：101.
收稿日期：1998-09-21, 百拇医药