陈旧性创伤性腰椎管狭窄症的后路手术治疗  

Posterior approach treatment of old traumatic lumbar spinal stenosis

作　　者：杜俊杰[1] 罗卓荆[1] 李新奎[1] 李明全[1] 

机构地区：[1]第四军医大学西京医院骨科研究所,西安710032

出　　处：《中国矫形外科杂志》2008年第22期1695-1697,共3页Orthopedic Journal of China

摘　　要：[目的]探讨采用椎板减压、髓核摘除、椎体间植骨融合并CAPSTONE融合器植入、椎弓根螺钉内固定的方法（TLIF）对陈旧性创伤性腰椎管狭窄、腰椎轻度后突、椎间隙狭窄的后路手术治疗。[方法]因创伤造成下腰椎椎管、椎间隙狭窄，腰椎轻度后突畸形20例，男13例，女7例；年龄22—49岁，平均31．4岁。其中L3，4例，L4.5 10例，L5 S1 6例。1例患者为伤后4年接受手术，3例患者为伤后9—15个月手术，6例患者为伤后3—6个月手术，10例患者为伤后1～3个月手术。所有病例均采用狭窄部位的椎板扩大减压，髓核摘除、椎体间植骨融合并CAP-STONE融合器植入、椎弓根螺钉内固定的方法（TLIF）进行手术治疗。术后1周，病人配带胸腰髂支具下床活动。[结果]经上述手术方法处理的病例，术后1周内病人的腰痛、下肢疼痛、肌力及感觉的减退均有不同程度的恢复，术后X线片证实，狭窄的腰椎间隙恢复，同时恢复了腰椎的生理弯曲。经1～3年的临床随访，20例患者均有明显的神经功能恢复和改善，平均Frankel分级改善1．4级。复查X线片，20例患者植骨均愈合，椎间隙高度及生理弯曲角度没有丢失。[结论]对陈旧性、创伤性腰椎管狭窄患者，恢复椎体原有的高度已不可能，在进行减压解除对神经压迫的同时，进行椎体间的植骨，同时植入椎间融合器，用椎弓根钉棒系统进行固定，既有利于植骨愈合，恢复椎间隙高度，恢复腰椎的生理弯曲，又有利于病人早期下床进行功能锻炼，防止卧床带来的并发症。此方法简单，操作便利，临床并发症少，值得临床推广。[ Objective ] To evaluate the posterior approach treatment of old traumatic lumbar spinal stenosis, lumbar kyphosis,intervertebral space stenosis using vertebral plate decompression, nucleus pulposus removal, intervertebral fusion and CAPSTONE cage insertion and internal fixation with pedicle screw and rod,TLIF. [ Method] Twenty patients with low lumbar spinal canal and intervertebral space stenosis ,lumbar kyphosis caused by trauma were enrolled in this study. There were 13 males and 7 females,with an average age of 31.4 years （range 22 -49）. Four had lesions of L3.4,10 of L4.5 and 6 of L5S1. One patient was treated at 4 years after injury ,3 within 9 - 15 months ,6 within 3 -6 months and 10 within 1 -3 months after injury. All patients were treated with vertebral plate decompression, some serious patients underwent laminectomy decompression, nucleus pulposus removal,intervertebral fusion, CAPSTONE cage insertion and internal fixation with pediele screw and rod, TLIF. One week after surgery, patients could wear thoracic waist-lilac orthosis and take out-of-bed activity. [ Result] All the patients lumbodynia, lower limb pain, muscle strength and hypoesthesia improved within one week after operation. X-rays showed that both the intervertebral space and the physiological curvature improved to some degrees. Twenty patients were followed up （ ranged, 1 to 3 years） and the clinical outcomes were good. The average Frankel grade was 1.4. Re-X-rays showed that .interbody fusion was achieved in all 20 patients. No loss was found about the altitude of the intervertebral space and the physiological curvature. [ Conclusion] For patients with old traumatic lumbar spinal stenosis, the recovery of body altitude is almost impossible. This method is simple and has less complications. It can be widely used in the clinical practice.

关 键 词：创伤 腰椎管狭窄 治疗 

分 类 号：R687.3[医药卫生—骨科学]