腰椎管成形加透明质酸钠注射预防硬膜外黏连

A Clinical Study on Prevention of Epidural Scar Adhesion by the Use of Laminotomy Displacement Laminoplasty and Medical Sodium Hyaluronate Gel

目的评价腰椎管成形术加透明质酸钠凝胶预防硬膜外瘢痕黏连的临床应用效果。方法 100例腰椎管狭窄症、多节段腰椎间盘突出症患者分为两组(各50例),单纯组仅行腰椎管成形术,联合组同时给予透明质酸钠凝胶。观察下肢痛视觉模拟评分,按日本矫形外科协会下腰痛评分标准评定临床疗效,术后6个月复查X线片观察椎板愈合情况,并行MRI扫描观察测量椎管内形态、硬膜囊减压后改变情况。结果两组术后1 d、2周下肢痛视觉模拟评分没有统计学差异(P>0.05),术后3 d、1周评分有统计学意义(P<0.01)。两组术后临床恢复分级无统计学意义(P>0.05)。两组椎板愈合情况、矢状位椎管矢径同椎间盘水平无显著性差异(P>0.05),联合组硬膜囊面积优于单纯组,具有显著性差异(P<0.05)。结论两种手术方式均能减少硬膜外瘢痕黏连,腰椎管成形术联合应用透明质酸钠凝胶比单独手术预防效果好。

Objective To evaluate the clinical effect of laminotomy displacement laminoplasty and medical sodium hyaluronate gel on prevention of epidural scar adhesion.Methods 100 cases including lumbar spinal stenosis（50 cases） and multitude segments lumbar disc hemiation（50 cases） were divided into two groups,the simple group was treated only by laminotomy displacement laminoplasty,the combined group was treated by the same method combined with medical sodium hyaluronate gel.The outcomes were assessed on lower limb VAS scoring system,according to JOA（Japanese Orthopaedics Association） score of spine to evaluate the clinical effect,observed the vertebral lamina healing up by X rays at 6th months,the radius vector of sagittal spinal canal and the thecal sac cross sectional area were measured by MRI.All data were analysed with statistics.Results There is no significant difference between lower limb VAS score in two groups at 1st day,2nd week after operation（P〉0.05）,and there is significant difference at 3th day,1st week（P〈0.01）.There is no significant difference between the postoperative clinical recovery effect（P〉0.05）.Between the vertebral lamina healing up,the radius vector of sagittal spinal canal there is no significant difference（P〉0.05）,but there is significant difference betwee the thecal sac cross sectional area（P〈0.05）.Conclusion The both surgical techniques can minimize the epidural scar adhesion,but laminotomy displacement laminoplasty combined with medical sodium hyaluronate gel has a better effect than simple operation.