椎板回植椎管成形治疗严重胸腰椎爆裂性骨折伴椎管狭窄  

Recapping laminoplasty for the treatment of severe burst fractures of thoracolumbar vertebra complicated with spinal stenosis

作　　者：李洪斌[1] 张兴群[1] 陈四木[1] 金伟强[1] 郑俊[1] 

机构地区：[1]杭州师范大学医学院附属余杭医院骨科,浙江杭州311100

出　　处：《中国骨伤》2008年第6期445-446,共2页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨椎板回植椎管成形治疗严重胸腰椎爆裂性骨折伴椎管狭窄的手术技巧、疗效及适应证。方法:41例胸腰椎骨折伴椎管狭窄患者,采用椎板回植椎管成形术。观察术后伤椎椎管大小、脊柱的稳定性、椎体高度的恢复及神经功能恢复情况。结果:全部病例经1～3年的随访,伤椎椎体前缘高度由术前58%恢复至97%,椎体后缘(中柱)高度由术前76%恢复至98.7%,Cobb角由术前平均24.6°恢复至术后1.8°。伤椎椎管剩余容积由术前43%恢复至术后93%。瘫痪恢复按Frankel分级:A级中1例无变化,余40例均提高1～3级。结论:椎板回植椎管成形治疗严重胸腰椎爆裂性骨折伴椎管狭窄是一种较理想的手术方法,此方法操作相对简单、安全,彻底解除神经及硬膜囊压迫的同时扩大了椎管,杜绝了继发性椎管狭窄,重建了后柱结构,增加了脊柱稳定性,值得推广。Objective：To investigate operation skills, therapeutic effects and indications of racapping laminoplasty for the treatment of severe burst fractures of thoracolumbar vertebra complicated with spinal stenosis. Methods：In the study,41 patients with severe burst fractures of thoracolumbar vertebra complicated with spinal stenosis were treated with recapping laminoplasty. After the treatment, the size of vertebral canal, spinal stability, altitude recovery of vertebral body and rehabilitation of nerve function were observed. Results： All the patients were followed up and the duration ranged from 1 to 3 years. The anterior height of compressed vertebral bodies restored from preoperative 58% to postoperative 97% ,posterior height was from preoperative 76% to postoperative 98.7%. The Cobb angle was corrected from preoperative 24.6° to postoperative 1.8°, and the size of vertebral canal restored from preoperative 43% to postoperative 93%. According to Frankel classification, 1 patient who were at A grade had no changes and others improved by 1 to 3 degrees. Condusion：This is an ideal operation method for treating burst fractures of thoracolumbar vertebra with spinal stenosis, which is simple, safe and enlarging vertebral canal, at the same time completely decompressing the dura mater and nerve roots. This method eliminated secondary spinal stenosis, reconstructed posterior column and increased spinal stability.

关 键 词：胸椎 腰椎 椎管狭窄 骨折 骨科手术方法 

分 类 号：R683.2[医药卫生—骨科学] R681.5[医药卫生—外科学]