撬拨椎板回植胸腰椎管成形术

Canal-expansive Laminoplasty with Unclenching and Reimplantation of Vertebral Lamina

目的 :探讨与总结采用撬拨椎板回植椎管成形术在胸腰椎管手术应用中的安全、可靠和优越性。方法 :自1996年 4月～ 2 0 0 0年 5月应用特制骨凿和一定的技术路线进行撬拨椎板回植胸腰椎管成形术 78例 ,其中胸腰椎体压缩性骨折骨块移入椎管 8例 ,腰椎管狭窄侧隐窝狭窄 2 7例 ,腰椎间盘突出症 3 8例 ,椎管肿瘤 5例 ,均获得成功并取得很好的临床疗效。结果 :本组全部病人均随访 6个月以上 (6个月～ 4年 ) ,全部病例都在术后 2～ 3个月达到良好的骨性愈合 ,未见骨不愈合、回植椎板移入椎管或有移入倾向。未见截骨前缘过度增生对硬膜产生新的压迫等。无症状复发和胸腰椎不稳。结论 :经 78例手术应用证明 ,撬拨椎板回植椎管成形术在椎管手术应用中安全可靠、疗效好 ,具有避免椎管内粘连和瘢痕形成。

Objective:To evaluate security,reliability and advantage of canal expansive laminoplasty with unclenching and reimplantation of vertebral lamina in thoracolumbar spine.Methods:From April 1996 to May 2000,canal expansive laminoplasty with unclenching and reimplantation of vertebral lamina in thoracolumbar spine was performed by specially made osteotome and certain technique in 78 patients,including 8 cases of thoracolumbar burst fracture with displaced fragment into the canal,27 cases of lumbar spinal stenosis,38 cases of lumbar herniation of disc and 5 cases of vertebral canal tumors.Results:All of the patients were followed up for more than 6 months(from 6 months to 4 years),and got bony healing of reimplanted lamina,from 2 to 3 months postoperatively. No nonunion, displacement of reimplanted lamina,overgrowth of anterior bone edge of osteotomy,no recompression of the nerves and instability of thoracolumbar spine occurred in this group.Conclusion:Outcome of 78 patients demonstrates that canal expansive laminoplasty with unclenching and reimplantation of vertebral lamina in thoracolumbar spine has advantages of avoiding adhesion and scar formation of the canal,restoring the anatomy and keeping stability of the spine.