颈、腰椎多节段椎管狭窄症的临床特点及手术治疗*

目的探讨颈、腰椎多节段椎管狭窄症的临床特点、手术治疗及临床疗效分析。方法回顾性分析2012年7月至2016年7月本院收治的24例颈、腰椎多节段椎管狭窄症患者的临床资料，其中男19例，女5例，年龄39～80岁，平均年龄（57.5±8.6）岁，病程6～36个月。24例患者术前影像学显示颈、腰椎2个以上节段椎管同时受压，临床表现为四肢麻木，间歇性跛行，行走不稳无力，上、下肢病理征阳性等。选择行单纯颈椎手术20例，单纯行腰椎手术2例，颈、腰椎分期手术2例。术前测量C3-6椎管矢状径比值，比较术前、术后末次随访时颈椎及腰椎的日本骨科学会（JOA）评分及Oswestry功能障碍指数（ODI），评估临床疗效。结果本组24例均顺利完成手术。术中平均出血量（277.1±141.8）mL，手术时间（134.6±40.6）min。术前测量C3-6椎管矢状径比值的加权平均数为0.736±0.086。24例患者术后随访18～36个月，平均（24.2±5.1）个月。所有患者切口均I期愈合，均未发生医源性神经损害；术后2例出现伤口脑脊液渗漏，经对症处理后愈合；2例出现C5神经根麻痹，经神经营养及康复锻炼后均获得良好恢复。末次随访时颈椎及腰椎JOA评分分别为（13.8±1.8，23.0±2.4），较术前（7.7±1.8，12.3±2.3）显著升高（P<0.05），颈椎及腰椎JOA评分平均改善率为（67.6±14.2）%及（64.8±11.9）%。末次随访时ODI评分（27.4±7.6）较术前评分（56.5±6.9）显著降低（P<0.05）。结论颈、腰椎多节段椎管狭窄症临床并不少见，部分患者伴有发育性颈椎管狭窄。手术优先处理主病灶，可达到改善患者肢体功能及提高生活质量的目的。

英文摘要:

Objective To investigate the clinical characteristics, surgical treatment and clinical curative effect of multilevel spinal stenosis in cervical and lumbar. Methods From July 2012 to July 2016, a retrospective analysis of 24 cases with multilevel spinal stenosis in cervical and lumbar. There were 19 males and 5 females, aged from 39 to 80 years (average, 57.5±8.6 years) and 6 to 36 months duration. The preoperative imaging of 24 cases showed cervical and lumbar multilevel spinal canal compression at the same time, and the clinical manifestations were limb numbness, intermittent claudication, walking instability and weakness, and positive pathological signs. Cervical decompression was performed in 20 cases, lumbar decompression in 2 case, and staged decompression in 2 cases. Preoperative measurement of the sagittal diameter ratio of C3-6 were performed. Clinical outcomes were evaluated and the Japan Orthopaedic Association Score (JOA) and Oswestry disability Index (ODI) in preoperation and postoperation were compared at the last follow-up. Results All the 24 patients in this group successfully completed the operation. Mean blood loss was (277.1±141.8) mL. The mean operation time was (134.6±40.6) min. The preoperative measurement of the sagittal diameter of C3-6 vertebral canal was 0.736 ± 0.086. All patients were followed up from 18 to 36 months (average, 24.2±5.1 months). All patients had stage I incision healing and there was no iatrogenic neural damage. Two cases of postoperative wound cerebrospinal fluid leakage and healed after symptomatic treatment, and 2 cases of cervical fifth nerve root palsy and recovered well by nerve nutrition and rehabilitation exercise. At the last follow-up, the JOA score of cervical and lumbar vertebrae were (13.8±1.8, 23.0±2.4), which were significantly higher than that of preoperative score (7.7±1.8, 12.3±2.3) (P< 0.05), respectively. The average improvement rate of JOA score of cervical and lumbar vertebrae were (67.6±14.2)% and (64.8±11.9)%, respectively. The ODI score (27.4±7.6) at the last follow-up was significantly lower than the preoperative score (56.5±6.9) (P < 0.05). Conclusion Multilevel spinal stenosis in cervical and lumbar is not uncommon, and some patients with developmental cervical spinal stenosis. Surgical treatment of primary lesions can improve the limb function and the quality of life.

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