棘突间V型截骨显露在巨大腰椎间盘突出症手术中的应用

Application of interspinous V-shaped osteotomy to huge lumbar intervertebral disc herniation surgery

目的评价巨大腰椎间盘突出手术中应用棘突间V型截骨显露在椎管减压和减少神经损害的作用。方法2009年1月q012年12月收治25例巨大腰椎间盘突出症患者，男15例，女10例，年龄28～62（36±7．9）岁，合并腰椎退变性滑脱7例，属于再次手术者2例。采用后正中切口，棘突旁分离椎旁肌群，棘突间“V形”截骨使棘突与棘上、棘间韧带形成骨韧带复合体，向对侧牵开扩大椎板间的显露和视野。结果25例患者均获随访，随访时间6～24个月，平均随访时间10．5个月。本组无新增腰椎不稳病例，棘突截骨均为骨性愈合，无神经损伤并发症。术后腰腿痛症状获明显改善，JOA评分由术前的8～14（9．2±2．2）分提高到21～26（24．3±1．9）分，改善率为58．9％～85．7％（76．3±5．9）％。结论棘突间V型截骨可充分显露椎板间隙，解除压迫、缓解症状，同时保留脊柱后柱解剖结构，对减少腰椎不稳及神经损伤并发症的发生有一定作用。

Objective To prospectively evaluate the effect of interspinous V-shaped osteotomy uncovering for spinal canal decom- pression on huge lumbar intervertebral disc herniation. Methods From January 2009 to December 2012, 25 patients with huge lumbar intervertebral disc herniation including 15 males and 10 females with an age of 28 - 62 （ 36 ± 7.9 ） years were performed operation. Of the patients, 7 suffered from combined lumbar degenerative slippage and 2 underwent reoperation. We made posterior central incision, separated vertebral muscles beside spinous process, constituted a bone ligament complex formation with supraspinal ligament, interspinal ligament and spinous process by interspinous V-shaped osteotomy and expanded interspinal vision. Results The 25 patients were followed up for 6 -24 （10.5） months. They all reached osseous healing, without postoperative complications such as new lumbar spinal instability and nerve injury. Lumbar and crural pain symptomsimproved significantly. JOA score increased from preoperative 8 - 14 （9.2±2.2） up to 21 - 26 （ 24.3 ± 1.9）, with an improved rate of 58.9% - 85.7%. Conclusion Interspinous V-shaped osteotomy can be used in fully showing the vertebral plate clearance and decompressing canalis spinalis in order to alleviate symptoms with posterior spinal anatomical structure retention. It will be a benefit to lowering complications such as lumbar instability and nerve injury.