伴有或无人工椎板重建术的椎管减压术治疗腰椎管狭窄症比较  

Total laminectomy decompression combined with or without artificial vertebrae lamina reconstruction for treatment of lumbar canal stenosis

作　　者：李世梁 蔡贤华[2] 朱小明 连育才 孙海东 李悫 李育敏 

机构地区：[1]江西省赣州市中医院骨科,赣州431000 [2]中国人民解放军武汉总医院骨科,武汉430070

出　　处：《中国矫形外科杂志》2017年第23期2118-2122,共5页Orthopedic Journal of China

摘　　要：[目的]比较腰椎管狭窄症患者行后路全椎板减压内固定,伴有或无人工椎板植入重建的临床疗效。[方法]2013年3月~2015年2月共收治34例采用后路全椎板减压内固定术式的腰椎管狭窄症患者,其中男18例,女16例,年龄48~76岁,平均(56.6±7.2)岁。按是否使用人工椎板重建分为两组,15例行单纯全椎板减压内固定术(单纯减压组),19例行全椎板减压内固定联合人工椎板重建术(重建组),统计两组手术时间和术中出血量,术前、术后1周、末次随访临床症状JOA评分、CT观察人工椎板融合率及椎管矢状径。[结果]单纯减压组间手术时间和术中出血量均明显小于重建组,差异有统计学意义(P<0.05),两组术后1周JOA评分较术前显著进步,差异有统计学意义(P<0.05),但术后1周两组间JOA评分差异无统计学意义(P>0.05);术后1周单纯减压组CT椎管矢状径明显小于重建组,差异有统计学意义(P<0.05)。所有患者术后获24~36个月(平均25.6个月)随访,末次随访时单纯减压组JOA评分显著低于重建组,两组间差异有统计学意义(P<0.05);末次随访时单纯减压组CT椎管矢状径明显小于重建组,差异有统计学意义(P<0.05)。CT示术后3~6个月人工椎板与受体骨接触界面模糊、间隙消失。所有患者均无感染,内固定松动、断裂等并发症。[结论]后路全椎板减压内固定联合人工椎板植入椎管成形治疗腰椎管狭窄症,可防止术后瘢痕粘连入椎管,有效扩大椎管大小,临床效果显著。[Objective] To compare clinical outcomes of total laminectomy decompression combined with or without artificial vertebrae lamina reconstruction for treatment of lumbar canal stenosis. [Methods] From March 2013 to February 2015, 34 patients of the lumbar canal spinal stenosis were treated with total laminectomy decompression, including 18 males and 16 fe- males with a mean age of 56.6＋7.2 years （range 48-76 years）. According whether or not combined with artificial lamina recon- struction, the 34 patients were divided into two groups, including 15 patients with laminectomy only （the decompression group） and 19 patients with laminectomy combined with lamina reconstruction （the reconstruction group）. The operative time, blood loss and the JOA score were compared between the two groups. Computed tomography was used to measure bone fusion and sag- ittal diameter of the lumbar spinal canal pre-operatively, at 1 week postoperatively and the last follow-up. [Results] The decom- pression group had statistically shorter operative time with less blood loss than the reconstruction group （P〈0.05）. The JOA scores significantly increased at 1 week after operation compared with those before operation in both groups, although no statisti- cal differences between the two groups at the same time points （P〉O.05）. The sagittal diameter of the involved spinal canal in the decompression group was statistically less than the reconstruction group （P〈O.05）. All patients were followed up for 24 to 36 months with an average of 25.6 months. At the latest follow up, the JOA score in the decompression group were significantly less than the reconstruction group （P〈0.05）, additionally, the sagittal canal diameters in the decompression group were still less than the reconstruction group （P〈0.05）. Computed tomography indicated that the interface between artificial vertebral lamina and the recipient bone disappeared at 3 to 6 months postoperatively. There was no infection, implant loosening or broken in an

关 键 词：腰椎管狭窄症 椎板切除减压 人工椎板 椎板重建 

分 类 号：R687.3[医药卫生—骨科学]