椎板切开复位固定椎管成形在椎管手术的临床应用

Clinical application of laminoplasty by opening and replanting the vertebral plate in the spinal canal surgery

目的总结椎板切开复位固定椎板成形在椎管手术的疗效和安全性。方法回顾性分析37例椎管手术病例,其中颈段9例,胸腰段28例;21例采用椎板成形术(椎板成形组),16例采用传统的椎板切除术(椎板切除组)。术后复查CT、MRI,并随访6个月～1年,其中28例胸腰段椎管内病变,对比术前及术后1年脊柱X-线正侧位片,测量正侧位Cobb角。结果椎板成形组术后未见明显不良反应,椎板切除组术后有血肿瘢痕入侵及不明原因的腰腿疼痛等情况。28例胸腰段椎管内病变中,15例采用椎板成形术,手术前后Cobb角无明显变化(P>0.05),13例采用传统椎板切除术,术后Cobb角较术前有所增大(P<0.05)。结论椎管内病变应用椎板成形术从解剖上重建椎管结构,对比传统的椎板切除术,有利于保留椎管完整性,保护脊柱稳定性,减少并发症,该方法简便实用、安全、可靠,值得临床推广。

Objective To summary the efficacy and safety of laminoplasty by regrafting and fixing vertebral plate in the spinal canal surgery. Methods Clinical data of 37 patients, who received vertebral canal surgery for cervical segment lesion in 9 and thoracic and lumbar segment lesion in 28, were analyzed retrospectively. The laminoplasty was performed in 21 cases （laminoplasty group） and the traditional laminectomy in 16 （laminectomy group）. All the patients were reviewed by CT and MRI during a follow-up period of 6 months to 1 year. Among 28 cases with thoracic and lumbar lesion, the Cobb angle in lateral and fxontal plain X-rays was measured at the preoperation and 1 year postoperation. Results There was no obvious adverse reaction in laminoplasty group. There were postoperative hematoma scar invasion and unexplained waist pain in laminectomy group. Among the 28 patients with thoracic and lumbar lesions, 15 receiving laminoplasty showed no significant change in Cobb angle after the operation （P 〉 0.05）, and 13 with traditional laminectomy presented a significant enlargement in Cobb angle postoperation （P 〈 0.05）. Conclusions To reconstruct vertebral canal structures for vertebral canal lesion by laminoplasty is more beneficial to maintain integrity of the vertebral canal and stability of the spine and reduce the complications compared with additional laminectomy, and simple, practical, safe and reliable, thus being worthy to be popularized clinically.