腰椎管狭窄症不同治疗方法的研究进展
Research Progress on Different Treatment Methods for Lumbar Spinal Stenosis
DOI: 10.12677/acm.2025.1551460, PDF,   
作者: 包志彬：内蒙古医科大学第一临床医学院，内蒙古 呼和浩特；苏义拉图：内蒙古医科大学附属医院骨科，内蒙古 呼和浩特
关键词: 腰椎管狭窄症；药物治疗；物理治疗；椎板切除术；椎间融合术；疗效；Lumbar Spinal Stenosis； Drug Therapy； Physical Therapy； Laminectomy； Intervertebral Fusion； Therapeutic Effect
摘要: 腰椎管狭窄症(Lumbar Spinal Stenosis, LSS)是指椎管内有效空间减少导致硬膜囊及神经根受压，继而引发腰腿疼痛、间歇性跛行、下肢无力，以及鞍区麻木和二便功能异常等一系列临床症状。腰椎管狭窄症作为一种常见的脊柱外科疾病，在成年人群中有症状的LSS的患病率约为11%，并且会随着年龄的增长而增加。LSS有多种治疗方法，本文将系统阐述各种治疗方法的适应症及优缺点，为LSS患者的临床治疗提供依据。
Abstract: Lumbar spinal stenosis (LSS) refers to the condition where the effective space within the spinal canal is reduced, causing compression of the dural sac and nerve roots, and subsequently leading to a series of clinical symptoms such as low back and leg pain, intermittent claudication, lower extremity weakness, saddle numbness, and abnormal bowel and bladder functions. As a common spinal surgical disease, the prevalence of symptomatic LSS in the adult population is approximately 11%, and it increases with age. There are various treatment methods for LSS. This article will systematically elaborate on the indications, advantages, and disadvantages of each treatment method to provide a basis for the clinical treatment of LSS patients.
文章引用：包志彬, 苏义拉图. 腰椎管狭窄症不同治疗方法的研究进展[J]. 临床医学进展, 2025, 15(5): 997-1004. https://doi.org/10.12677/acm.2025.1551460

参考文献

[1] Amundsen, T., Weber, H., Lilleas, F., Nordal, H.J., Abdelnoor, M. and Magnaes, B. (1995) Lumbar Spinal Stenosis. Spine, 20, 1178-1186. [Google Scholar] [CrossRef] [PubMed]
[2] Johnson, K., Rosén, I. and Udén, A. (1992) The Natural Course of Lumbar Spinal Stenosis. Clinical Orthopaedics and Related Research, 279, 82-86. [Google Scholar] [CrossRef] 
[3] Genevay, S. and Atlas, S.J. (2010) Lumbar Spinal Stenosis. Best Practice & Research Clinical Rheumatology, 24, 253-265. [Google Scholar] [CrossRef] [PubMed]
[4] Jenis, L.G. and An, H.S. (2000) Spine Update. Spine, 25, 389-394. [Google Scholar] [CrossRef] [PubMed]
[5] Inufusa, A., An, H.S., Lim, T., Hasegawa, T., Haughton, V.M. and Nowicki, B.H. (1996) Anatomic Changes of the Spinal Canal and Intervertebral Foramen Associated with Flexion-Extension Movement. Spine, 21, 2412-2420. [Google Scholar] [CrossRef] [PubMed]
[6] Comer, C., Williamson, E., McIlroy, S., Srikesavan, C., Dalton, S., Melendez-Torres, G., et al. (2023) Exercise Treatments for Lumbar Spinal Stenosis: A Systematic Review and Intervention Component Analysis of Randomized Controlled Trials. Clinical Rehabilitation, 38, 361-374. [Google Scholar] [CrossRef] [PubMed]
[7] Denard, P.J., Holton, K.F., Miller, J., Fink, H.A., Kado, D.M., Yoo, J.U., et al. (2010) Lumbar Spondylolisthesis among Elderly Men. Spine, 35, 1072-1078. [Google Scholar] [CrossRef] [PubMed]
[8] Jonsson, B. and Stromqvist, B. (1993) Symptoms and Signs in Degeneration of the Lumbar Spine. A Prospective, Consecutive Study of 300 Operated Patients. The Journal of Bone and Joint Surgery, British Volume, 75, 381-385. [Google Scholar] [CrossRef] [PubMed]
[9] Miyakoshi, N., Hongo, M., Kasukawa, Y., Ishikawa, Y. and Shimada, Y. (2011) Prevalence, Spinal Alignment, and Mobility of Lumbar Spinal Stenosis with or without Chronic Low Back Pain: A Community-Dwelling Study. Pain Research and Treatment, 2011, 1-5. [Google Scholar] [CrossRef] [PubMed]
[10] Migliorini, F., Maffulli, N., Eschweiler, J., Tingart, M. and Baroncini, A. (2021) Non-Steroidal Anti-Inflammatory Drugs and Gabapentinoids for Chronic Lumbar Pain: A Bayesian Network Meta-Analysis of Randomized Controlled Trials. British Medical Bulletin, 138, 85-95. [Google Scholar] [CrossRef] [PubMed]
[11] 刘书华, 戈才华, 刘志安. 消痹止痛散联合甲钴胺在老年腰椎管狭窄患者治疗中的应用分析[J]. 中国现代医生, 2018, 56(6): 12-15.
[12] Cragg, J.J., Jutzeler, C.R., Grassner, L., Ramer, M., Bradke, F. and Kramer, J.L.K. (2020) Beneficial “Pharmaceutical Pleiotropy” of Gabapentinoids in Spinal Cord Injury: A Case for Refining Standard-of-Care. Neurorehabilitation and Neural Repair, 34, 686-689. [Google Scholar] [CrossRef] [PubMed]
[13] Matsudaira, K., Seichi, A., Kunogi, J., Yamazaki, T., Kobayashi, A., Anamizu, Y., et al. (2009) The Efficacy of Prostaglandin E1 Derivative in Patients with Lumbar Spinal Stenosis. Spine, 34, 115-120. [Google Scholar] [CrossRef] [PubMed]
[14] 戚智健, 李宇卫, 沈晓峰, 等. 中药复方治疗退行性腰椎管狭窄症疗效及安全性的Meta分析[J]. 湖南中医杂志, 2022, 38(2): 131-139.
[15] Fritz, J.M., Lurie, J.D., Zhao, W., Whitman, J.M., Delitto, A., Brennan, G.P., et al. (2014) Associations between Physical Therapy and Long-Term Outcomes for Individuals with Lumbar Spinal Stenosis in the SPORT Study. The Spine Journal, 14, 1611-1621. [Google Scholar] [CrossRef] [PubMed]
[16] 殷佳宝. 益督通痹经验汤剂联合功能锻炼治疗退行性腰椎管狭窄症的疗效观察[J]. 临床医药文献电子杂志, 2017, 4(97): 19151-19153+19155.
[17] 柴俊飞, 袁幸芳. 通督调脊手法结合中药、牵引治疗老年退行性腰椎管狭窄症61例[J]. 福建中医药, 2012, 43(2): 24-25.
[18] 王冰, 张涛, 庞浩. 温针灸联合针刀松解黄韧带治疗老年腰椎管狭窄临床观察[J]. 实用中医药杂志, 2018, 34(11): 1376-1378.
[19] 王琴玉, 庄礼兴. 针刀疗法的发展对针灸学科的启示[J]. 中国针灸, 2012, 32(6): 481-483.
[20] Slätis, P., Malmivaara, A., Heliövaara, M., Sainio, P., Herno, A., Kankare, J., et al. (2011) Long-Term Results of Surgery for Lumbar Spinal Stenosis: A Randomized Controlled Trial. European Spine Journal, 20, 1174-1181. [Google Scholar] [CrossRef] [PubMed]
[21] Kwon, C., Yoon, S., Lee, B. and Leem, J. (2019) Acupotomy for the Treatment of Lumbar Spinal Stenosis. Medicine, 98, e16662. [Google Scholar] [CrossRef] [PubMed]
[22] Friedly, J., Chan, L. and Deyo, R. (2007) Increases in Lumbosacral Injections in the Medicare Population. Spine, 32, 1754-1760. [Google Scholar] [CrossRef] [PubMed]
[23] Deer, T., Sayed, D., Michels, J., Josephson, Y., Li, S. and Calodney, A.K. (2019) A Review of Lumbar Spinal Stenosis with Intermittent Neurogenic Claudication: Disease and Diagnosis. Pain Medicine, 20, S32-S44. [Google Scholar] [CrossRef] [PubMed]
[24] Manchikanti, L. (2012) Results of 2-Year Follow-Up of a Randomized, Double-Blind, Controlled Trial of Fluoroscopic Caudal Epidural Injections in Central Spinal Stenosis. Pain Physician, 5, 371-384. [Google Scholar] [CrossRef] 
[25] Manchikanti, L. (2014) Randomized Trial of Epidural Injections for Spinal Stenosis Published in the New England Journal of Medicine: Further Confusion without Clarification. Pain Physician, 4, E475-E487. [Google Scholar] [CrossRef] 
[26] Manchikanti, L. (2012) Lumbar Interlaminar Epidural Injections in Central Spinal Stenosis: Preliminary Results of a Randomized, Double-Blind, Active Control Trial. Pain Physician, 1, 51-63. [Google Scholar] [CrossRef] 
[27] Parr, A.T. (2009) Lumbar Interlaminar Epidural Injections in Managing Chronic Low Back and Lower Extremity Pain: A Systematic Review. Pain Physician, 1, 163-188. [Google Scholar] [CrossRef] 
[28] Cuckler, J.M., Bernini, P.A., Wiesel, S.W., Booth, R.E., Rothman, R.H. and Pickens, G.T. (1985) The Use of Epidural Steroids in the Treatment of Lumbar Radicular Pain. A Prospective, Randomized, Double-Blind Study. The Journal of Bone & Joint Surgery, 67, 63-66. [Google Scholar] [CrossRef] 
[29] Wilson-MacDonald, J., Burt, G., Griffin, D. and Glynn, C. (2005) Epidural Steroid Injection for Nerve Root Compression. The Journal of Bone and Joint Surgery, British Volume, 87, 352-355. [Google Scholar] [CrossRef] [PubMed]
[30] Overdevest, G.M., Jacobs, W., Vleggeert-Lankamp, C., Thomé, C., Gunzburg, R. and Peul, W. (2015) Effectiveness of Posterior Decompression Techniques Compared with Conventional Laminectomy for Lumbar Stenosis. Cochrane Database of Systematic Reviews, 2015, CD010036. [Google Scholar] [CrossRef] [PubMed]
[31] 侯继春, 何人可, 曹杨. 单侧椎弓根螺钉固定系统在腰椎退行性疾病治疗中的研究进展[J]. 中华骨与关节外科杂志, 2020, 13(1): 67-72.
[32] 杨伟铭, 林定坤. 单侧椎弓根螺钉固定椎间融合技术的研究进展[J]. 中国脊柱脊髓杂志, 2015, 36(5): 462-464.
[33] 李洪达. 单侧及双侧椎弓根螺钉内固定联合椎间融合术治疗单侧神经症状为主的腰椎管狭窄症的疗效对比[D]: [硕士学位论文]. 扬州: 扬州大学, 2021.
[34] 史彦海, 李关兴, 徐艾强, 等. 单侧椎板减压椎间植骨椎弓根钉固定治疗腰椎管狭窄症[J]. 临床骨科杂志, 2021, 24(5): 631-634.
[35] 刘良乐, 戴鸣海, 唐小君, 等. 单侧椎弓根螺钉内固定椎间融合治疗腰椎退行性疾病的中期疗效评价[J]. 中国骨伤, 2015, 28(4): 313-317.
[36] 张玉红, 冯波, 戴国华, 等. 经单孔分体内镜下单侧减压与双侧减压治疗单侧症状腰椎管狭窄症的临床疗效对比[J]. 中国脊柱脊髓杂志, 2023, 33(11): 994-1002.
[37] 王国新, 罗宝宁, 马友才. 开窗减压术与全椎板切除椎间融合内固定术治疗腰椎椎管狭窄的疗效及安全性分析[J]. 实用医院临床杂志, 2020, 17(4): 227-230.
[38] 王磊. 双侧开窗减压与全椎板切除内固定治疗老年退变性椎管狭窄的疗效对比[J]. 系统医学, 2022, 7(13): 79-82+94.
[39] Lestini, W.F., Fulghum, J.S. and Whitehurst, L.A. (1994) Lumbar Spinal Fusion: Advantages of Posterior Lumbar Interbody Fusion. Surgical Technology International, 3, 577-590.
[40] Cole, C.D., McCall, T.D., Schmidt, M.H. and Dailey, A.T. (2009) Comparison of Low Back Fusion Techniques: Transforaminal Lumbar Interbody Fusion (TLIF) or Posterior Lumbar Interbody Fusion (PLIF) Approaches. Current Reviews in Musculoskeletal Medicine, 2, 118-126. [Google Scholar] [CrossRef] [PubMed]
[41] Phan, K., Thayaparan, G.K. and Mobbs, R.J. (2015) Anterior Lumbar Interbody Fusion versus Transforaminal Lumbar Interbody Fusion—Systematic Review and Meta-Analysis. British Journal of Neurosurgery, 29, 705-711. [Google Scholar] [CrossRef] [PubMed]
[42] 刘美富, 吴秀锋, 丁思齐, 等. 微创通道经椎间孔入路与开放经椎间孔腰椎椎体间融合术治疗老年性腰椎退行性病变的疗效观察[J]. 中国社区医师, 2024, 40(23): 35-37.
[43] 郭松, 张冶, 尚军, 等. 机器人辅助微创和开放徒手经椎间孔腰椎椎体间融合术治疗单节段退行性腰椎滑脱临床疗效及对邻近节段退变的影响[J]. 中国修复重建外科杂志, 2024, 38(11): 1379-1385.
[44] 林铖. 斜外侧入路与经椎间孔入路腰椎间融合术治疗严重腰椎管狭窄症的临床疗效比较[D]: [硕士学位论文]. 苏州: 苏州大学, 2023.
[45] 李鋆, 徐杰, 肖毓华. ALIF在治疗L5/S1腰椎滑脱中的应用[J]. 中国医学创新, 2019, 16(11): 169-172.
[46] Albanese, V., Raich, A., Dettori, J., Sherry, N., Balsano, M. and Barbagallo, G. (2014) Lumbar Lateral Interbody Fusion (LLIF): Comparative Effectiveness and Safety versus PLIF/TLIF and Predictive Factors Affecting LLIF Outcome. Evidence-Based Spine-Care Journal, 5, 28-37. [Google Scholar] [CrossRef] [PubMed]
[47] 齐德泰, 赵轶波, 陆向东, 等. 侧方椎间融合术与后路减压融合术对腰椎退行性疾病疗效的对比观察[J]. 骨科临床与研究杂志, 2025, 10(1): 18-25.
[48] Perez-Roman, R.J., Gaztanaga, W., Lu, V.M. and Wang, M.Y. (2022) Endoscopic Decompression for the Treatment of Lumbar Spinal Stenosis: An Updated Systematic Review and Meta-Analysis. Journal of Neurosurgery: Spine, 36, 549-557. [Google Scholar] [CrossRef] [PubMed]

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