摘要
背景:目前对腰椎管狭窄症的诊断、治疗方式的选择、责任节段的定位诊断、减压范围的确定、固定方式、融合方式的选择,外科治疗的适应证及治疗后疗效的判定仍没有统一的标准和定论。目的:通过查阅大量文献阐述外科治疗方式的优缺点及减压治疗范围,对减少脊柱结构的损伤、保持脊柱的稳定性具有重要价值。方法:由第一作者应用计算机检索1990年1月至2014年1月PubMed、中国期刊全文数据库(CNKI)、万方数据库中相关文献,选择与腰椎管狭窄治疗进展、非手术治疗及各种外科治疗方式(椎板切除减压方式、植骨融合、植骨融合加内固定、非融合性内固定及微创减压等)治疗腰椎管狭窄症的有关文献。纳入42篇符合标准的文章分析描述。结果与结论:对患者年龄、狭窄的类型及程度、椎间盘及椎管的形态作出综合评价,严格把握外科治疗适应证。外科治疗要处理好减压与稳定的关系,在充分减压的基础上最大限度的保留脊柱结构,应根据患者的临床症状、体征及影像学特征综合考虑选择外科治疗减压的范围和植骨融合和(或)内固定,避免盲目性减压和非症状区域的减压,只有慎重选择方可提高腰椎管狭窄症的临床治疗效果,使外科治疗有的放矢,节约时间,减少创伤。
BACKGROUND： There were no uniform standards or conclusion in the diagnosis of lumbar spinal stenosis, choice of therapeutic manner, location of affected segment, range of decompression, choice of fixation and fusion, indication of surgical treatment and the judgment of posttreatment effects. OBJECTIVE： To search abundant literatures on the advantage and disadvantages of surgical therapies and the range of decompression therapy is of great value on reducing the injury to spine structure and keeping spine stability. METHODS： The first author retrieved PubMed, China National Knowledge Infrastructure and Wanfang Database by computer for related articles published from January 1990 to January 2014. Literatures were about treatment progress of lumbar spinal stenosis, non-surgery therapy and various surgical manners（Laminectomy, fusion, fusion and fixation, non-fusion fixation and minimally invasive decompression） in treatment of lumbar spinal stenosis. A total of 42 literatures were included. RESULTS AND CONCLUSION： Patients’ age, type and degree of stenosis and morphology of intervertebral disc and vertebral canal were comprehensively evaluated. The indication of surgical treatment was strictly analyzed.The correlation of decompression and stability was handled during surgical therapy. On the basis of thorough decompression, spinal column was kept maximally. In accordance with patients’ clinical symptoms, signs and imaging characteristics, the range of decompression, fusion and（or） fixation were considered to avoid blindness decompression and non-symptomatic area decompression. Only careful choice could elevate the clinical therapeutic efficacy of lumbar spinal stenosis, make surgical therapy target, save time, and reduce trauma.
出处
《中国组织工程研究》
CAS
CSCD
2014年第22期3581-3586,共6页
Chinese Journal of Tissue Engineering Research
