椎板成形术在多节段椎管内病变手术中的临床应用

Clinical application of laminoplasty to surgery for multisegmental intraspinal lesions

目的探讨椎板成形术在多节段椎管内病变手术中的应用效果。方法 2009年4月至2013年4月采用显微手术治疗56例多节段（6～7个节段14例,3～5个节段42例）椎管内病变患者,术中使用磨钻磨开两侧的椎板,形成棘突椎板复合体后取出,切除椎管内病变后复位,用钛板固定,完成椎管成形。结果本组病变全切除52例,全切率为92.9%。椎管成形术中未损伤硬脊膜及脊神经根,术后复查MRI及CT均显示棘突椎板复合体复位良好,无椎管狭窄。术后随访1～5年,所有患者均没有发现继发性椎管狭窄、脊柱后凸畸形及脊柱不稳。结论对于多节段椎管内病变,术中对椎板的处理采用椎管成形术,可使椎管的骨性结构得到解剖复位,可保持术后脊柱的稳定性,防止医源性椎管狭窄症的发生。

Objective To explore the technique and advantages of laminoplasty and its effect on multisegmental spinal lesions.MethodsThe clinical data of 56 patients with multisegmental intraspinal lesions, who received laminoplasty after the resection of theintraspinal lesions from April, 2009 to April, 2013, were retrospectively analyzed. The lesions invaded 6 or 7 segments of the spinalcords in 14 patients and 3～5 segments in 42 patients. Both the sides of the laminae were opened by the grinding knife and the complex ofspinous process and vertebral plate was formed and taken out. The complex was reduced and fixed by titanium plate, and thelaminoplasty was completed after the resection of intraspinal lesions.ResultsOf 56 patients with multisegmental intraspinal lesions, 52（92.9%） received total resection of the lesions and 4（7.1%） subtotal. No patients died. There was not damage to the dura mater spinalisand spinal nerve root in all the patients. The postoperative MRI and CT showed that the complex of spinous process and vertebral platewas well reduced and the vertebral canal stenosis did not occur in all the patients. The following-up from 1 to 5 years showed that therenot were the secondary stenosis of vertebral canal, kyphosis or instability of the spinal column in all the patients.ConclusionsTheabove-mentioned surgical method can provide adequate exposure for the resection of the multisegmental intraspinal lesions. The bonystructure of the spinal canal can be anatomically reconstructed and the stability of spinal column after the operation can be maintained,and the iatrogenic stenosis of the vertebral canal after the operation can be prevented by the laminoplasty in the patients withmultisegmental intraspinal lesions, in whom the laminoplasty was safe and may improve curative effect of the surgery on themultisegmental intraspinal lesions.