腰椎管狭窄症的治疗进展
摘要
腰椎管狭窄症(lumbar spinal stenosis, LSS)是导致腰痛及腰腿痛等常见腰椎病的病因之一,又称腰椎椎管狭窄综合征。LSS的主要表现为休息或者蹬自行车时没有不适症状,而在步行或站立一段时间后会逐渐出现腰部酸困、下肢疼痛、麻木无力等不适,只有坐下休息一段时间后才能继续行走,即间歇性跛行。LSS是渐进性发展的疾病,随着我国人口老龄化趋势的进展,患病者逐年增多,严重影响中老年人的日常生活。LSS治疗方法众多,如中医药、物理治疗、药物治疗、椎管减压术、椎间融合术等。此文通过检索文献资料,对LSS的治疗进行了综述,以期为临床工作提供参考。
引文
[1]张会生,张建军,杨阳,等.腰椎管狭窄症的临床观察[J].中华实用诊断与治疗杂志,2009,23(3):291-292.
[2]Siebert E,PrüssH,Klingebiel R,et al.Lumbar spinal stenosis:syndrome,diagnostics and treatment[J].Nat Rev Neurol,2009,5(7):392-403.
[3]Yabuki S,Fukumori N,Takegami M,et al.Prevalence of lumbar spinal stenosis,using the diagnostic support tool,and correlated factors in Japan:a population-based study[J].J Orthop Sci,2013,18(6):893-900.
[4]许鸿智.不同病理改变下退行性腰椎管狭窄症保守治疗转归[D].广州:广州中医药大学,2011.
[5]Onel D,Sari H,D?nmez C.Lumbar spinal stenosis:clinical/radiologic therapeutic evaluation in 145 patients.Conservative treatment or surgical intervention?[J].Spine(Phila Pa 1976),1993,18(2):291-298.
[6]Rodrigues LCL,Natour J.A double-blind,randomized controlled,prospective trial assessing the effectiveness of oral corticoids in the treatment of symptomatic lumbar canal stenosis[J].J Negat Results Biomed,2014,13:13.
[7]Yaksi A,Ozg?nenel L,Ozg?nenel B.The efficiency of gabapentin therapy in patients with lumbar spinal stenosis[J].Spine(Phila Pa1976),2007,32(9):939-942.
[8]Bansal S,Lubelski D,Thompson NR,et al.Membrane-stabilizing agents improve quality-of-life outcomes for patients with lumbar stenosis[J].Global Spine J,2016,6(2):139-146.
[9]Matsudaira K,Seichi A,Kunogi J,et al.The efficacy of prostaglandin E1 derivative in patients with lumbar spinal stenosis[J].Spine(Phila Pa 1976),2009,34(2):115-120.
[10]Kim HJ,Kim JH,Park YS,et al.Comparative study of the efficacy of limaprost and pregabalin as single agents and in combination for the treatment of lumbar spinal stenosis:a prospective,double-blind,randomized controlled non-inferiority trial[J].Spine J,2016,16(6):756-763.
[11]许崧杰,陈学明,崔利宾,等.痹祺胶囊治疗腰肌劳损的临床疗效观察[J].中华中医药杂志,2010,25(6):958-959.
[12]黄建萍.中西医结合治疗退变性腰椎管狭窄症[J].齐齐哈尔医学院学报,2010,31(7):1079.
[13]Bicket MC,Horowitz JM,Benzon HT,et al.Epidural injections in prevention of surgery for spinal pain:systematic review and metaanalysis of randomized controlled trials[J].Spine J,2015,15(2):348-362.
[14]卫沛然,邹德威,陈晓明,等.腰椎管狭窄病人疼痛的腰椎神经根管封闭治疗(英文)[J].中国矫形外科杂志,2013,21(17):1767-1770.
[15]史少岩,黄研生,郝定均.腰椎管狭窄的治疗进展[J].中国骨伤,2017,30(5):484-488.
[16]Shabat S,Arinzon Z,Folman Y,et al.Long-term outcome of decompressive surgery for lumbar spinal stenosis in octogenarians[J].Eur Spine J,2008,17(2):193-198.
[17]Shamji MF,Mroz T,Hsu W,et al.Management of degenerative lumbar spinal stenosis in the elderly[J].Neurosurgery,2015,77(Suppl 4):S68-S74.
[18]吴樾,张学利,袁武,等.腰椎节段性不稳定的解剖学和生物力学的研究[J].天津医科大学学报,2002,8(1):18-19.
[19]吴习威,王军,费勤勇.后路椎间盘镜下多节段有限减压治疗腰椎管狭窄症的疗效观察[J].颈腰痛杂志,2018,39(5):640-642.
[20]Yeung AT.Minimally invasive disc surgery with the Yeung endoscopic spine system(YESS)[J].Surg Technol Int,1999,8:267-277.
[21]程才,辛大森,王路,等.椎间孔镜TESSYS技术治疗单责任节段腰椎管狭窄症的近期结果[J].中国微创外科杂志,2018,18(10):920-923.
[22]钱宇,徐国健,金聪,等.腰椎管狭窄症致压因素与减压方式关系的研究[J].中华骨科杂志,2016,36(22):1417-1425.
[23]Hansraj KK,Cammisa FP Jr,O.Leary PF,et al.Decompressive surgery for typical lumbar spinal stenosis[J].Clin Orthop Relat Res,2001,384:10-17.
[24]Cloward RB.Posterior lumbar interbody fusion updated[J].Clin Orthop Relat Res,1985,193:16-19.
[25]Schmid R,Krappinger D,Blauth M,et al.Mid-term results of PLIF/TLIF in trauma[J].Eur Spine J,2011,20(3):395-402.
[26]李素明,杭柏亚,杨开锦.经椎间孔及经后路椎间融合术治疗退行性腰椎滑脱合并腰椎管狭窄的疗效对比[J].中国中西医结合外科杂志,2016,22(1):53-55.
[27]Park JS,Kim YB,Hong HJ,et al.Comparison between posterior and transforaminal approaches for lumbar interbody fusion[J].JKorean Neurosurg Soc,2005,37(5):340-344.
[28]Audat Z,Moutasem O,Yousef K,et al.Comparison of clinical and radiological results of posterolateral fusion,posterior lumbarinterbody fusion and transforaminal lumbar interbody fusion techniques in the treatment of degenerative lumbar spine[J].Singapore Med J,2012,53(3):183-187.
[29]Hunt T,Shen FH,Shaffrey CI,et al.Contralateral radiculopathy after transforaminal lumbar interbody fusion[J].Eur Spine J,2007,16(3 Suppl):311-314.
[30]Foley KT,Holly LT,Schwender JD.Minimally invasive lumbar fusion[J].Spine(Phila Pa 1976),2003,28(15 Suppl):S26-S35.
[31]肖波,毛克亚,王岩,等.微创经椎间孔腰椎椎体间融合术与传统后路腰椎椎体间融合术并发症的比较分析[J].脊柱外科杂志,2013,11(1):23-27.
[32]罗志平,饶海群,黄大江,等.通道辅助下微创经椎间孔椎体间融合术治疗腰椎退行性疾病的疗效观察[J].中华医学杂志,2015,95(33):2681-2685.
[33]石义华,周轶,晏雄伟,等.双切口Quadrant通道下微创经椎间孔椎间融合术治疗退行性腰椎疾病[J].骨科,2017,8(2):99-102.
[34]Silvestre C,Mac-Thiong JM,Hilmi R,et al.Complications and morbidities of mini-open anterior retroperitoneal lumbar interbody fusion:oblique lumbar interbody fusion in 179 patients[J].Asian Spine J,2012,6(2):89-97.
[35]秦世强,孙宇庆,倪文卓,等.OLIF与TLIF治疗退变性腰椎滑脱合并腰椎管狭窄症的疗效对比[J].实用骨科杂志,2018,24(7):628-632.
[36]Yang M,Zeng C,Guo S,et al.Digitalized design of extraforaminal lumbar interbody fusion:a computer-based simulation and cadaveric study[J].PLoS One,2014,9(8):e105646.256252
[37]杨明杰,曾诚,李立钧,等.腰椎椎间孔外椎体间融合术的生物力学分析[J].同济大学学报(医学版),2018,39(4):51-55.
[38]楚野,梁斌,曾佳兴,等.腰椎退变性疾病融合术后邻近节段退变的研究进展[J].中国脊柱脊髓杂志,2014,24(2):175-178.
[39]李华,王立涛.经椎板间入路椎管扩大减压Wallis系统动态固定治疗单节段腰椎管狭窄症的疗效[J].中国脊柱脊髓杂志,2016,26(6):562-564.
[40]吴海挺,蒋国强,卢斌,等.Dynesys动态稳定系统治疗多节段腰椎退变性疾病的中远期临床疗效观察[J].中国骨伤,2015,28(11):1000-1005.
[41]刘广武,王子滔,方忠,等.Dynesys系统治疗腰椎退变性疾病的早期疗效[J].骨科,2017,8(6):417-422.
[42]Wu H,Pang Q,Jiang G.Medium-term effects of Dynesys dynamic stabilization versus posterior lumbar interbody fusion for treatment of multisegmental lumbar degenerative disease[J].J Int Med Res,2017,45(5):1562-1573.
[43]Grob D,Benini A,Junge A,et al.Clinical experience with the Dynesys semirigid fixation system for the lumbar spine:surgical and patient-oriented outcome in 50 cases after an average of 2years[J].Spine(Phila Pa 1976),2005,30(3):324-331.
[44]Würgler-Hauri CC,Kalbarczyk A,Wiesli M,et al.Dynamic neutralization of the lumbar spine after microsurgical decompression in acquired lumbar spinal stenosis and segmental instability[J].Spine(Phila Pa 1976),2008,33(3):E66-E72.
[45]许俊川,杨雍,费琦.新型椎板间动态稳定系统-IntraSPINE的研究进展[J].中华医学杂志,2017,97(25):1988-1990.
[46]St-Pierre GH,Jack A,Siddiqui MM,et al.Nonfusion does not prevent adjacent segment disease:dynesys long-term outcomes with minimum five-year follow-up[J].Spine(Phila Pa 1976),2016,41(3):265-273.
[47]Sénégas J.Mechanical supplementation by non-rigid fixation in degenerative intervertebral lumbar segments:the Wallis system[J].Eur Spine J,2002,11(Suppl2):S164-S169.2018-11-29
[2]Siebert E,PrüssH,Klingebiel R,et al.Lumbar spinal stenosis:syndrome,diagnostics and treatment[J].Nat Rev Neurol,2009,5(7):392-403.
[3]Yabuki S,Fukumori N,Takegami M,et al.Prevalence of lumbar spinal stenosis,using the diagnostic support tool,and correlated factors in Japan:a population-based study[J].J Orthop Sci,2013,18(6):893-900.
[4]许鸿智.不同病理改变下退行性腰椎管狭窄症保守治疗转归[D].广州:广州中医药大学,2011.
[5]Onel D,Sari H,D?nmez C.Lumbar spinal stenosis:clinical/radiologic therapeutic evaluation in 145 patients.Conservative treatment or surgical intervention?[J].Spine(Phila Pa 1976),1993,18(2):291-298.
[6]Rodrigues LCL,Natour J.A double-blind,randomized controlled,prospective trial assessing the effectiveness of oral corticoids in the treatment of symptomatic lumbar canal stenosis[J].J Negat Results Biomed,2014,13:13.
[7]Yaksi A,Ozg?nenel L,Ozg?nenel B.The efficiency of gabapentin therapy in patients with lumbar spinal stenosis[J].Spine(Phila Pa1976),2007,32(9):939-942.
[8]Bansal S,Lubelski D,Thompson NR,et al.Membrane-stabilizing agents improve quality-of-life outcomes for patients with lumbar stenosis[J].Global Spine J,2016,6(2):139-146.
[9]Matsudaira K,Seichi A,Kunogi J,et al.The efficacy of prostaglandin E1 derivative in patients with lumbar spinal stenosis[J].Spine(Phila Pa 1976),2009,34(2):115-120.
[10]Kim HJ,Kim JH,Park YS,et al.Comparative study of the efficacy of limaprost and pregabalin as single agents and in combination for the treatment of lumbar spinal stenosis:a prospective,double-blind,randomized controlled non-inferiority trial[J].Spine J,2016,16(6):756-763.
[11]许崧杰,陈学明,崔利宾,等.痹祺胶囊治疗腰肌劳损的临床疗效观察[J].中华中医药杂志,2010,25(6):958-959.
[12]黄建萍.中西医结合治疗退变性腰椎管狭窄症[J].齐齐哈尔医学院学报,2010,31(7):1079.
[13]Bicket MC,Horowitz JM,Benzon HT,et al.Epidural injections in prevention of surgery for spinal pain:systematic review and metaanalysis of randomized controlled trials[J].Spine J,2015,15(2):348-362.
[14]卫沛然,邹德威,陈晓明,等.腰椎管狭窄病人疼痛的腰椎神经根管封闭治疗(英文)[J].中国矫形外科杂志,2013,21(17):1767-1770.
[15]史少岩,黄研生,郝定均.腰椎管狭窄的治疗进展[J].中国骨伤,2017,30(5):484-488.
[16]Shabat S,Arinzon Z,Folman Y,et al.Long-term outcome of decompressive surgery for lumbar spinal stenosis in octogenarians[J].Eur Spine J,2008,17(2):193-198.
[17]Shamji MF,Mroz T,Hsu W,et al.Management of degenerative lumbar spinal stenosis in the elderly[J].Neurosurgery,2015,77(Suppl 4):S68-S74.
[18]吴樾,张学利,袁武,等.腰椎节段性不稳定的解剖学和生物力学的研究[J].天津医科大学学报,2002,8(1):18-19.
[19]吴习威,王军,费勤勇.后路椎间盘镜下多节段有限减压治疗腰椎管狭窄症的疗效观察[J].颈腰痛杂志,2018,39(5):640-642.
[20]Yeung AT.Minimally invasive disc surgery with the Yeung endoscopic spine system(YESS)[J].Surg Technol Int,1999,8:267-277.
[21]程才,辛大森,王路,等.椎间孔镜TESSYS技术治疗单责任节段腰椎管狭窄症的近期结果[J].中国微创外科杂志,2018,18(10):920-923.
[22]钱宇,徐国健,金聪,等.腰椎管狭窄症致压因素与减压方式关系的研究[J].中华骨科杂志,2016,36(22):1417-1425.
[23]Hansraj KK,Cammisa FP Jr,O.Leary PF,et al.Decompressive surgery for typical lumbar spinal stenosis[J].Clin Orthop Relat Res,2001,384:10-17.
[24]Cloward RB.Posterior lumbar interbody fusion updated[J].Clin Orthop Relat Res,1985,193:16-19.
[25]Schmid R,Krappinger D,Blauth M,et al.Mid-term results of PLIF/TLIF in trauma[J].Eur Spine J,2011,20(3):395-402.
[26]李素明,杭柏亚,杨开锦.经椎间孔及经后路椎间融合术治疗退行性腰椎滑脱合并腰椎管狭窄的疗效对比[J].中国中西医结合外科杂志,2016,22(1):53-55.
[27]Park JS,Kim YB,Hong HJ,et al.Comparison between posterior and transforaminal approaches for lumbar interbody fusion[J].JKorean Neurosurg Soc,2005,37(5):340-344.
[28]Audat Z,Moutasem O,Yousef K,et al.Comparison of clinical and radiological results of posterolateral fusion,posterior lumbarinterbody fusion and transforaminal lumbar interbody fusion techniques in the treatment of degenerative lumbar spine[J].Singapore Med J,2012,53(3):183-187.
[29]Hunt T,Shen FH,Shaffrey CI,et al.Contralateral radiculopathy after transforaminal lumbar interbody fusion[J].Eur Spine J,2007,16(3 Suppl):311-314.
[30]Foley KT,Holly LT,Schwender JD.Minimally invasive lumbar fusion[J].Spine(Phila Pa 1976),2003,28(15 Suppl):S26-S35.
[31]肖波,毛克亚,王岩,等.微创经椎间孔腰椎椎体间融合术与传统后路腰椎椎体间融合术并发症的比较分析[J].脊柱外科杂志,2013,11(1):23-27.
[32]罗志平,饶海群,黄大江,等.通道辅助下微创经椎间孔椎体间融合术治疗腰椎退行性疾病的疗效观察[J].中华医学杂志,2015,95(33):2681-2685.
[33]石义华,周轶,晏雄伟,等.双切口Quadrant通道下微创经椎间孔椎间融合术治疗退行性腰椎疾病[J].骨科,2017,8(2):99-102.
[34]Silvestre C,Mac-Thiong JM,Hilmi R,et al.Complications and morbidities of mini-open anterior retroperitoneal lumbar interbody fusion:oblique lumbar interbody fusion in 179 patients[J].Asian Spine J,2012,6(2):89-97.
[35]秦世强,孙宇庆,倪文卓,等.OLIF与TLIF治疗退变性腰椎滑脱合并腰椎管狭窄症的疗效对比[J].实用骨科杂志,2018,24(7):628-632.
[36]Yang M,Zeng C,Guo S,et al.Digitalized design of extraforaminal lumbar interbody fusion:a computer-based simulation and cadaveric study[J].PLoS One,2014,9(8):e105646.256252
[37]杨明杰,曾诚,李立钧,等.腰椎椎间孔外椎体间融合术的生物力学分析[J].同济大学学报(医学版),2018,39(4):51-55.
[38]楚野,梁斌,曾佳兴,等.腰椎退变性疾病融合术后邻近节段退变的研究进展[J].中国脊柱脊髓杂志,2014,24(2):175-178.
[39]李华,王立涛.经椎板间入路椎管扩大减压Wallis系统动态固定治疗单节段腰椎管狭窄症的疗效[J].中国脊柱脊髓杂志,2016,26(6):562-564.
[40]吴海挺,蒋国强,卢斌,等.Dynesys动态稳定系统治疗多节段腰椎退变性疾病的中远期临床疗效观察[J].中国骨伤,2015,28(11):1000-1005.
[41]刘广武,王子滔,方忠,等.Dynesys系统治疗腰椎退变性疾病的早期疗效[J].骨科,2017,8(6):417-422.
[42]Wu H,Pang Q,Jiang G.Medium-term effects of Dynesys dynamic stabilization versus posterior lumbar interbody fusion for treatment of multisegmental lumbar degenerative disease[J].J Int Med Res,2017,45(5):1562-1573.
[43]Grob D,Benini A,Junge A,et al.Clinical experience with the Dynesys semirigid fixation system for the lumbar spine:surgical and patient-oriented outcome in 50 cases after an average of 2years[J].Spine(Phila Pa 1976),2005,30(3):324-331.
[44]Würgler-Hauri CC,Kalbarczyk A,Wiesli M,et al.Dynamic neutralization of the lumbar spine after microsurgical decompression in acquired lumbar spinal stenosis and segmental instability[J].Spine(Phila Pa 1976),2008,33(3):E66-E72.
[45]许俊川,杨雍,费琦.新型椎板间动态稳定系统-IntraSPINE的研究进展[J].中华医学杂志,2017,97(25):1988-1990.
[46]St-Pierre GH,Jack A,Siddiqui MM,et al.Nonfusion does not prevent adjacent segment disease:dynesys long-term outcomes with minimum five-year follow-up[J].Spine(Phila Pa 1976),2016,41(3):265-273.
[47]Sénégas J.Mechanical supplementation by non-rigid fixation in degenerative intervertebral lumbar segments:the Wallis system[J].Eur Spine J,2002,11(Suppl2):S164-S169.2018-11-29