棘突椎板复合体截骨原位回植椎管成形术治疗腰椎管狭窄症

Application of Osteotmy and Regrafting in Situ with Spinous Process and Vertebral Plate Complex for Canaloplasty in Lumbar Spinal Stenosis

目的:探讨腰椎棘突椎板复合体原位回植椎管扩大成形术手术要点,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28例,单节段减压16例,两节段减压12例。术后进行OSwestry疗效评分与影像学观察。结果:术后1年随访28例,疗效优良率87.4%,术后3年随访22例疗效优良率89.3%,术后CT显示椎管直径明显增加。回植的组织均无移位,全部骨性愈合。结论:该术式椎管显露充分,椎管结构完整保留,脊柱稳定性好。能防止瘢痕粘连压迫硬膜及神经根,尤其是远期效果好,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 nous process and vertebral plate complex for eanaloplasty and evaluate the clinical 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 28 cases, there were 16 cases in mono - segment, 12 Cases in two- segment. Postoperatively, oswestry evaluation score and imaging observation were carried out. Result： 28 cases had followed - up for one year and the excellent and good result was seen in 87.4% ; 22 cases had follow -up of 3 years, the rate of excellent and good result was 89.3%. Both sagittal and transverse diameter of lumbar vertebrae canal were increased notably in postoperative CT scanning. The regrafted region was synostosis in all cases examined. Conclusion： The technique can fully exposure the spinal canal thoroughly and keep anatomic structure of spinal canal, so the nerve root can not be adhered by scar. It is a plasty close stability of spine can be keeped and dure mater or to anatomic reconstruction.