“高架桥式”椎管扩大成形术行脊髓减压(13例报告)

"Viaduct" canal-expansive laminoplasty for decompression of the spinal cord

目的发育性椎管狭窄、连续型后纵韧带骨化、广泛椎管内占位预计不能全切除时,为避免椎管切除造成的脊柱后凸畸形或椎管单开门成形术后椎板塌陷对脊髓造成新的压迫,特设计本术式。方法俯卧位,切开皮肤,剥离两侧脊旁肌到小关节突,显露需减压的脊椎节段。用超声骨刀截断两侧的椎板根部,将整个椎板取下。手术结束后,取长度合适的微型双孔钛钢连接桥片将离断侧的椎板架起后,固定在小关节突上,使椎管扩大成型。结果“高架桥”术式13例:各部位椎管狭窄6例;颈椎后纵韧带骨化4例;地毯样脊膜瘤1例;髓内肿瘤次全切除2例。手术效果良好,术后影像学检查见椎管扩大,脊髓蛛网膜下腔恢复。结论“高架桥式”钛片固定椎管成形术能稳定固定椎板,防止了以往椎管成形术后椎板塌陷对脊髓造成新的压迫。椎管扩大成形确切牢靠,不影响小儿的脊柱发育。为第二次手术保留了完整的手术剥离路径。

Objective This surgical technique is specially developed to avoid kyphosis after laminectomy or lamina collapse after semi-open-door laminoplasty result in spinal cord compression when treating developmental spinal stenosis, successive type OPLL, extensive intra-canal occupying lesion that could not be totally removed. Methods Prone position, incised the skin, and striping both side paraspinal muscles to articular processes, exposed the segments for decompression. Cut off the laminas at both side lamina root. After operation, using titanium miniscrew-plates of suitable size to prop up and fixing the laminas to the lamina root and expand the canal. Results Used this ＂viaduct＂ technique in 13 cases：different location spinal stenosis 6 cases, OPLL 4 cases, extensive spinal meningioma 1 case, subtotal removal of intramedullary tumor 2 cases, with good effect. Postoperative images indicate expanded spinal canal and recovered spinal subarachnoid. Conclusions ＂Viaduct＂ titanium plate fixation laminoplasty can fix stably the laminas, prevent spinal cord compression secondary to laminas collapse after previous laminoplasty. Canal-expansive laminoplasty is reliable, does not influence spinal development of children, and reserve the complete pathway for reoperation.