腰椎板切除内固定术后骶棘肌疝的发生和治疗

Occurrence and treatment of sacral spinalis hernia after lumbar spine laminectomy and internal fixation

目的分析腰椎板切除内固定术后骶棘肌疝发生的原因,预防措施及治疗的方法。方法回顾研究分析2006年7月至2014年11月,北京中医药大学东直门医院450腰椎板切除减压内固定术后的患者,收集患者的一般资料、手术方式、术后疗效及随访,观察患者临床疗效。结果所有患者均成功完成腰椎板切除内固定术,2006年7月至2010年7月行腰椎板切除内固定的手术患者15例发生骶棘肌疝,2010年8月至2014年11月行腰椎板切除内固定术的患者无一例出现骶棘肌疝。15例患者通过佩戴腰围和局部理疗、针灸等对症治疗,腰部疼痛及腰部力量均有不同程度的加强。结论术中减少剥离范围,尽量保留棘突,重建筋膜、肌肉的附着点。可恢复韧带-筋肉复合体的完整性,可有效防止腰椎板切除内固定术后骶棘肌疝的发生。

Objective Analyze the causes, preventive measures and treatment of sacral spinalis hernia after lumbar spine laminectomy and internal fixation. Methods A retrospective study was conducted on 450 patients who underwent lumbar laminectomy and internal fixation in Dongzhimen hospital from June 2006 to November 2014. Demographic data, operative methods, postoperative outcome and follow-up were collected and observed. Results All 450 patients were successfully completed lumbar laminectomy and internal fixation. Sacral spinalis hernia occurred in 15 cases who had the operations from July 2006 to July 2010. While None found in the patients who underwent lumbar laminectomy and internal fixation between August 2010 and November 2014. Of these 15 cases, the patients were treated by wearing waist circumference, local physical therapy, acupuncture and other symptomatic treatment. After that, the waist pain and waist strength had been improved in varying degrees. Conclusion Minimize dissection in the operation, and attempt to preserve the attachment points of fascia and muscle can help to restore the integrity of ligament-muscle complex, which can effectively prevent the occurrence of sacral spinalis hernia after lumbar discectomy and internal fixation.