棘突椎板复合体截骨原位回植椎管成形术在胸腰椎手术中的应用

Application of osteotomy and regrafting in situ with spinous process and vertebral plate complex for canaloplasty in thoracolumbar spinal operation

目的探讨棘突椎板复合体截骨原位回植椎管成形术手术要点,评价临床应用效果.方法采用经棘突椎板截骨将椎管后部结构整块取下,处理完椎管内病变后再将后部结构原位回植固定,完成椎管成形.随访病例126例,男85例,女41例,年龄16～78岁,平均47岁.其中椎间盘突出症23例,椎管狭窄及合并椎间盘突出42例,椎管内占位性疾患32例,胸、腰椎骨折29例;患病节段位于胸段13例,胸腰段25例,腰段88例;单节段59例,2个节段42例,3个节段25例;未做内固定的105例,附加内固定的21例.结果所有病例的脊髓或神经根损伤均未加重,无感染,术后7～10 d摄X线片观察,棘突椎板均恢复原位连续性,截骨区无1例发生移位.随访1～3年,复查截骨回置区情况,摄X线片复查,回植的组织均无移位,全部骨性愈合.本组126例中,优82例,良33例,可8例,差3例,优良率91.3%.结论该术式能够充分显露椎管,保留椎管的解剖结构,术后能保持脊柱的稳定性,防止瘢痕粘连压迫硬膜及神经根,是一种接近于解剖性重建的成形术.

Objective To explore the operative main points on osteotomy and regrafting in situ with spinous process and vertebral plate complex for canaloplasty and evaluate the clinical effect. Methods Taking out the whole spinous process and vertebral plate and regrafting it in situ after the lesion in spinal canal cleared so as to form the canaloplasty. Of all the 126 cases, there were 85 males and 41 females with an average age of 47 years (range 16-78 years), and 23 were of prolapse of intervertebral disc, 42 spinal stenosis combined with prolapse of intervertebral disc, 32 space occupying lesions in spinal canal, 29 thoracolumbar fractures. There were 13 cases in thoracic segments, 25 in thoracolumbar segments and 88 in lumbar segments, and there were 59 cases in mono-segment, 42 in two-segment, 25 in three-segment. One hundred-five cases were treated without internal fixation, and 21 cases with internal fixation. Results Spinal cord or nerve root was not found injury aggravation after operation, and was free from infection. Spinous process and vertebral plate recovered succession in situ, osteotomy region was not found displacement by X-ray observation 7-10 days after operation. The regrafted region was synostosis in all cases examined after a follow-up for 1-3 years.The effect was excellent in 82 cases, good in 33, fair in 8 and bad in 3, and the excellent and good rate was 91.3%. Conclusion The technique can fully exposure the spinal canal thoroughly and keep anatomic structure of spinal canal, so the stability of spine can be keeped and dura mater or nerve root can not be adhered by scar. It is a plasty close to anatomic reconstruction.