腰椎后路棘突椎板连接块回植术的设计和应用

Clinical study of remove-implantation of spinal process lamina complex in lumbar vertebrae posterior surgery

目的:探讨腰椎后路棘突椎板连接块回植术的可行性和临床应用效果。方法:在腰椎后路手术中,根据病变范围,应用自制的椎板限制性骨刀切取棘突椎板连接块,处理完椎管内病变后再将棘突椎板连接块原位回植,应用此术式治疗52例腰椎间盘突出症及腰椎管狭窄症患者,观察其治疗效果并根据JOA标准进行功能评定。术前JOA评分8～16分,平均12.3分。结果:手术时间平均75min,出血量平均400ml,无神经损伤等并发症。随访4￣24个月,平均9.2个月,术后JOA评分25～29分,平均26.9分。棘突椎板连接块回植后均达到解剖复位,影像学动态观察无移位,无明显骨痂形成,未引起骨性椎管狭窄。50例术后平均3个月时达到骨性愈合,1例椎间隙感染,1例椎间盘突出复发,再次行棘突椎板连接块回植术时证实椎管内及椎管外粘连较轻,对二次手术没有造成困难。结论:腰椎后路棘突椎板连接块回植术手术视野开阔,棘突椎板连接块回植后有利于脊柱的完整性与稳定性,防止了椎管内外组织的互通粘连。

Objective：To explore the clinical effect of self-designed lumbar vertebrae posterior surgery. Method：Remove-implantation of spinal process lamina complex in lumbar vertebrae posterior surgery was performed in 52 cases with herniation of lumbar intervertebral disc and spinal canal stenosis.The preoperative and postoperative clinical effect of 52 cases was evaluated based on JOA scorring.Result：The average operation time was 75 minutes,the average volumn of blood loss was 400ml.Preoperative JOA score was 8-16,averaging 12.3,postoperative JOA score was 25-29,averaging 26.9.After an average followed-up of 9.2 months, no displacement, no formation of osteophyte and no narrowing of spinal canal was observed radiologically,and bone fusion was achieved in 50 cases in 3 months.Conclusion：The method has the advantages of wider vision,the stability and integrity of vertebra column can be ensured,which is help to decrease vertebral canal adhesion.