保留棘突韧带腰椎管扩大减压治疗椎管狭窄伴侧弯  

Posterior decompressing laminoplasty with preservation of spinous ligament complex for adult lumbar canal stenosis accompanied with degenerative scoliosis

作　　者：陈宇飞 李京元 张红星 张金康 郑超 薛静 厉晓杰 彭页 杜俊杰 CHEN Yu-fei;LI Jing-yuan;ZHANG Hong-xing;ZHANG Jin-kang;ZHENG Chao;XUE Jing;LI Xiao-jie;PENG Ye;DU Jun-jie(Department of Orthopaedics,Air Force Medical Center of PLA,Beijing 100142,China)

机构地区：[1]空军特色医学中心骨科,北京100142

出　　处：《中国矫形外科杂志》2020年第21期1926-1929,共4页Orthopedic Journal of China

基　　金：首都特色临床医学应用发展专项项目(编号:Z161100000116057);军队后勤科研重点项目(编号:BKJ17J004、BKJ20J004)。

摘　　要：[目的]探讨保留棘突韧带复合体腰椎管扩大减压术治疗腰椎管狭窄症(LCS)伴退变性脊柱侧凸(ADS)的临床结果。[方法]回顾2014年1月1日~2019年1月1日本院收治的25例ADS合并LCS患者,采用保留棘突韧带复合体腰椎管扩大减压术治疗。总结其围手术期、随访和影像资料。[结果]25例患者均顺利完成手术,手术时间(95.61±10.43)min,手术出血量(83.78±12.45)ml,术后引流量(128.62±31.42)ml,术后卧床时间(2.86±0.85)d。发生脑脊液漏1例(4.00%),手术切口脂肪液化1例(4.00%),无其他严重手术并发症。均随访(13.75±4.35)个月,随时间推移,患者腰痛和腿痛VAS、ODI评分显著下降(P<0.05),而连续行走距离显著增加(P<0.05)。影像方面,术后椎管面积显著增大(P<0.05),而侧凸Cobb角、矢状垂直间距(SVA)和腰椎前凸角(LL)无显著变化(P>0.05)。[结论]保留棘突韧带复合体腰椎管扩大减压术治疗ADS伴LCS具有医源性损伤小,并发症少,患者满意度高的优点。[Objective]To investigate the clinical outcomes of posterior decompressing laminoplasty with preservation of spinous ligament complex for lumbar canal stenosis(LCS)accompanied with adult degenerative scoliosis(ADS).[Methods]A retrospective study was conducted on 25 patients who underwent posterior decompressing laminoplasty with preservation of spinous ligament complex for LCS accompanied with ADS from January 2014 to January 2019.The perioperative,follow-up and radiographic documents were summarized.[Results]All the 25 patients had surgical procedures performed smoothly with operation time of(95.61±10.43)min,intraoperative blood loss of(83.78±12.45)ml,postoperative drainage of(128.62±31.42)ml,postoperative bed rest of(2.86±0.85)days.Except cerebrospinal fluid leakage in a case(4.00%),and incision fat liquefaction in another case(4.00%),no serious complications happened in anyone of them.As time went during follow-up lasted for(13.75±4.35)months,the VAS for back pain and leg pain,as well as ODI score significantly decreased(P<0.05),whereas the distance of continuous walking significantly increased(P<0.05).With regard of radiographic assessment,the spinal canal areas on average were significantly enlarged postoperatively compared those before operation(P<0.05),whereas the Cobb’s angle of scoliosis,sagittal vertical axis(SVA)and lumbar lordosis(LL)remained unchanged postoperatively compared with those before operation(P>0.05).[Conclusion]This posterior decompressing laminoplasty with preservation of spinous ligament complex takes advantages of minimizing iatrogenic trauma,reducing complications,and high patient satisfaction for one or two levels of LCS accompanied with ADS.

关 键 词：退变性脊柱侧凸 腰椎管狭窄症 保留棘突韧带复合体腰椎管扩大减压术 

分 类 号：R682.3[医药卫生—骨科学]