预防腰椎管术后硬膜外纤维瘢痕粘连的实验研究与临床观察  

Prevention of epidural fibrous scar and adhesion after laminotomy displacement laminoplasty:experimental and clinical study

作　　者：常彦海[1] 刘时璋[1] 徐洪海[1] 罗振群[1] 

机构地区：[1]陕西省人民医院骨科,陕西西安710068

出　　处：《颈腰痛杂志》2008年第2期120-123,共4页The Journal of Cervicodynia and Lumbodynia

基　　金：陕西省社发攻关(编号:2003K10-G110)

摘　　要：目的观察腰椎板切开椎板关闭成形术后椎板愈合、椎管内纤维瘢痕增生和硬膜外粘连情况。方法采用山羊14只制作动物模型,切开两个节段腰椎椎板,分别采用原位椎板关闭和椎板部分后移关闭两种手术方式,观察术后2、4、6、8、12、16、24周,椎板愈合和椎管内粘连情况。临床上采用腰椎板切开椎板原位关闭成形术处理椎管内病变患者46例,通过X线和CT检查观察椎板愈合和椎管内粘连情况。结果术后12周与16周,关闭的椎板均骨性连接;24周,关闭的椎板完全骨性愈合。后移椎板连接处较原位关闭椎板明显增厚;椎管内壁连接处轻微隆起。椎管内少量瘢痕增生粘连,可锐性分离。临床病例术后半年X线提示椎板截骨线消失。CT提示椎板截骨线骨质愈合,未见椎板连接处大量骨痂生成,椎管完整,硬膜囊无变形移位,硬膜同椎板间隙清楚。结论椎板原位关闭较椎板部分后移关闭骨质愈合速度快、愈合质量高。腰椎板切开椎板关闭成形术能有效地防止椎管内纤维瘢痕增生和硬膜外粘连的形成。Objective To investingate the effects of the vertebral lamina healing up,fibrous scar formation and epidural adhesion after laminotomy,displacement laminoplasty. Methods 14 goats were used as the animal model in this study. Laminotomy was performed in two segment intervertebral lamina,one segment was placed by reducing the lamina,another segment vertebral lamina was displaced backward about 2mm,the vertebral laminae healing up,fibrous scar formation and epidural adhesion were observed 2,4,6,8,12,16 and 24 weeks postoperatively. Clinically,46 cases of lumbar vertebral canal diseases were made with laminotomy displacement laminoplasty,then observed the vertebral lamina healing up and epidural adhesion by X rays and CT scans. Results 12 to 16 weeks following the operation,all the reducing laminae connected osteally;24 weeks later,the reducing laminae healed osteally,but the displaced backward laminae that connected were obvious inerassafion. The walls of vertebral canal were slight hunch,there were a few fibrous scar formation and epidural adhesion in the vertebral canal. Clinically,X rays showed all the reducing laminae healed osteally half a year after operation,CT scans showed the connected lamina had healed osteally,the vertebral wall was integrited,the dura sac was no distortied and without spinal stenosis. Condusion The findings indicate that all the reducing vertebral laminae healing up may have more speedy and better quality than the displaced backward laminae,laminotomy displacement laminoplasty has a better effect on prevention fibrous scar formation and epidural adhesion.

关 键 词：椎板切开术 椎管成形术 硬膜外粘连 预防 

分 类 号：R681.5[医药卫生—骨科学]