保留棘上韧带的全椎板截骨回植治疗腰椎管狭窄症的效果分析

Total Laminectomy and Replantation with Preservation of Supraspinal Ligament to treat the Lumbar Spinal Canal Stenosis

目的评价保留棘上韧带的全椎板截骨回植椎管成形术在治疗腰椎管狭窄症中的临床疗效。方法采集泰安市中心医院骨科2006年12月-2010年12月所治疗的腰椎管狭窄症中有随诊记录的72例,按照不同的手术方式分为3组,A组24例,手术采取全椎板截骨减压治疗腰椎管狭窄症,B组21例,手术采取全椎板截骨回植椎管成形术治疗腰椎管狭窄症,C组27例,手术采取保留棘上韧带的全椎板截骨回植椎管成形术治疗此病。比较3组病例术后3个月及24个月的腰椎稳定性及JOA评分系统改善率,进行统计学分析,比较其差异是否有显著意义。结果随访3个月时3组病例稳定性无显著性差别,随访24个月B,C组病例腰椎稳定性与1组病例有显著性差别,B和C组之间无显著性差别,JOA评分系统改善率的比较,3个月时三组间的改善率无显著性差异(P>0.05),三种手术方式都取得明显的手术效果,24个月时三组间的改善率有显著性差异(P<0.05)。结论采取保留棘上韧带的全椎板截骨回植椎管成形术治疗腰椎管狭窄症显露充分,减压彻底可靠,可明显减少术后腰椎的失稳,尽量避免医源性椎管狭窄的发生。

Objective To evaluate the clinical application and efficacy of total laminectomy and replantation with preservation of supraspinal ligament to treat the lumbar spinal canal stenosis.Methods We analyzed retrospectively the clinical data of 72 patients follow up clinic from December,2006 to December,2010 in Tai＇an Central Hospital..Among all the cases,there were 46 males and 25 females age from 50 to 76,average age was 61.4 years old.;Course of illness ranged from 6 months to 20 years,average 5 years 2 months.According to different surgical methods into three groups： Group A 24 cases,the surgery resects of total laminectomy treat the spinal canal stenosis.Group B 21 cases,the surgery resects of total laminectomy and replantation treat the spinal canal stenosis.Group C 27 cases,total laminectomy and replantation with preservation of supraspinal ligament treat the lumbar spinal canal stenosis.The therapeutic effect was assessed based on the JOA low back pain scoring system and lumbar stability among the three group.Results 3 months after surgery,there were not significant differences in lumbar stability among the three groups.24 months after surgery,there were not significant differences in lumbar stability between Group B and Group C,there were significant differences Group B,C and Group A.Group B and Group C is better than Group A.To compare the rate of improvement derived from JOA scoring system,the researcher found no significant difference（P0.05） between good rate among the three groups after 3 months.These three kinds of operation methods can significantly ease clinical symptoms of patients.24 months after surgery,there were significant differencesamong the three groups.Group B and Group C is better than Group A.Conclusions The operation method of total Laminectomy and RePlantation with preservation of supraspinal ligament to treat the Lumbar Spinal canal Stenosis is very good..This method is beneficial to spinal stability.Which can decrease adherent chance of scar of spinal dura mater and obviously increase the area of the spinal canal