有限减压保留后方韧带复合体结构在腰椎减压融合手术中的意义

The significance of limited decompression and preservation of posterior ligamentous complex in lumbar decompression and fusion

目的探讨术中保留相邻节段关节突关节囊、部分棘突、椎板及韧带复合体,对腰椎融合内固定手术后腰椎稳定性的影响,及预防相邻间隙退变的作用。方法回顾性分析2006-05-2014-05实施腰椎融合手术患者132例,依据手术方案的不同,将其分为两组:A组42例采用全椎板减压腰椎融合内固定术,B组90例行有限减压腰椎融合内固定术,术中保留相邻节段关节突关节囊、部分棘突、椎板及韧带复合体等后方结构。结果 132例患者术后随访2~5年,A组术后发生相邻间隙退变13例,占32.5%。B组发生8例,占8.9%。两组的差异有统计学意义(P<0.05)。结论与传统的全椎板减压脊柱融合手术相比,采取有限减压、术中保留相邻间隙关节突关节囊、部分棘突、椎板及韧带复合体,能最大限度地维持脊柱的稳定性,降低相邻间隙退变的发生率。

Objective To investigate the adjacent lumbar facet joint capsule, part of spinous process, lamina and ligament sparing surgepy, influence on lumbar stability of lumbar fusion and internal fixation, and the preventive effect of adjacent segment degeneration. Methods a retrospective analysis of the May 2006 ~2014 year in May the implementation of 132 cases of lumbar fusion surgery patients, according to the different operation scheme, it can be divided into two groups： A group of 42 cases were treated with laminectomy lumbar fusion and internal fixation, 90 cases in group B with limited decompression of lumbar fusion and internal fixation, with adjacent segment zygapophysea] joint capsule part of spinous process, lamina and ligament complex posterior structure preserving surgery. Results 132 cases were followed up for 2-5 years, and the adjacent space degeneration oceun＇ed in A group （n=13）, accounting for 32.5%. Group B occurred in 8 cases, accounting for 8.9%. The difference between the two groups was statistically significant （P〈0.05）. Conclusion compared with traditional lamineetomy and spinal fusion surgery, take limited decompression, with preservation of adjacent facet joint capsule, part of spinous process, lamina and ligament complex, to maximize the maintenance of the stability of the spine, reduce the incidence of adjacent segment degeneration.