改良腰椎板截骨回植治疗失稳性腰椎间盘突出症  

Treatment of unstable lumbar intervertebral disc herniation by modified lamina osteotomy replantation

作　　者：刘琮[1] 徐洪海[2,3] 邹庆洋[2,3] 郭雄[2,3] 刘宗智[2,3] 罗振群[2,3] 李勇[2,3] 祁洁[2,3] 刘军[2,3] 任鹏宇[2,3] 范亚一[2,3] 

机构地区：[1]西安医学院,陕西西安710000 [2]西安交通大学第三临床学院 [3]陕西省人民医院骨科,陕西西安710068

出　　处：《中国骨伤》2013年第11期918-922,共5页China Journal of Orthopaedics and Traumatology

基　　金：陕西省科学技术研究发展计划项目(编号:2011K14-08-02;2001K10-G9);西安市科技计划项目[(编号:HM1121(1)]~~

摘　　要：目的:评价改良腰椎板截骨回植在失稳性腰椎间盘突出症中的疗效。方法:2009年3月至2011年8月对63例失稳性腰椎间盘突出症的患者行髓核摘除+椎间融合+椎弓根螺钉内固定+改良腰椎板截骨回植手术,男33例,女30例;年龄22～68岁,平均48.4岁;病程3个月～13年,平均38.8个月。患者均有不同程度的腰腿疼痛,X线片、CT及MR检查诊断为失稳性腰椎间盘突出症。观测手术前后ODI和JOA评分、并发症发生率、影像学回植椎板愈合率及腰腿痛复发率。结果:62例患者切口Ⅰ期愈合,1例Ⅱ期愈合,无下肢深静脉血栓及椎间隙感染等并发症出现。61例获1年或以上随访,平均随访时间33个月。术中神经损伤发生2例,硬膜囊损伤发生1例;术后1年回植椎板愈合58例;腰痛复发4例,腿痛复发1例。术后2周、6、12个月的ODI及JOA评分显著优于术前(P<0.05)。结论:改良椎板截骨回植术治疗失稳性腰椎间盘突出症具有较低的术中神经硬膜囊损伤率和腰腿痛复发率、较高的椎板愈合率和较好的临床评分,是一种安全、有效的新方法,为临床失稳性腰椎间盘突出症手术开辟了一种新的术式。Objective：To evaluate the clinical effects of the modified lamina replantation for the treatment of unstable lumbar intervertebral disc herniation. Methods：From March 2009 to August 2011,63 patients with unstable lumbar iutervertebral disc herniation were treated by discectomy,interbody fusion,pedicle screw fixation, and modified lamina replantation. There were 33 males and 30 females with an average age of 48.4 years old ranging from 22 to 68 years old. The average dura- tion of disease was 38.8 months ranging from 3 months to 13 years. All patients had lower back and leg pains. X-ray, CT and MR results showed unstable lumbar intervertebral disc herniation. Preoperative and postoperative ODI, JOA scores, complication incident rates,radiographic healing rates, and lower back and leg pain recurrence rates were observed and recorded. Results： Sixty-two incisions were healed at first stage, 1 at second stage. There were no complications such as deep vein thrombosis, intervertebral infection and so on. Sixty-one patients were followed up for more than one year, and the mean duration was 33 months. Nerve and dural injury occurred in 2 patients and 1 patient respectively. One-year fusion happened in 58 patients while the recurrence of lower back pain and leg pain after 1 year were noted in 4 patients and 1 patient respectively. ODI, and JOA scores were respectively re-assessed at 2 weeks, 6 mouths and 1 year after the operation, and the results showed a significant difference from the preoperative scores （P〈0.05）. Conclusion： Modified lamina replantation for unstable lumbar intervertebral disc herniation showed lower rates of dural and nerve damage, as well as a higher lamina healing rate, lower back and leg pain recovery rate, and a better clinical score. It is a safe and efficient operation choice for lumbar spine surgery.

关 键 词：腰椎 椎间盘移位 脊柱融合术 外科手术 

分 类 号：R681.53[医药卫生—骨科学]