椎板截骨原位回植小钛板固定术治疗腰椎管狭窄症

Lamina replantation in situ with tiny titanium plate fixation secondary to lamina osteotomy for lumbar spinal stenosis

[目的]探讨椎板截骨原位回植小钛板固定术治疗腰椎管狭窄症的疗效。[方法]2002年1月~2006年3月86例患者在本院采用椎板截骨原位回植小钛板固定术治疗腰椎管狭窄症。选择其中有完整随访记录的43例纳入本回顾研究,男29例,女14例,平均年龄(59.34±12.42)岁(29~75岁),随访时间10~14年,平均(11.82±8.65)年。记录临床资料与并发症,采用视觉模拟评分(VAS)、Oswestry功能障碍指数评分(ODI),并测量CT椎管矢状径、椎管横径评价临床疗效。[结果]43例患者均顺利手术,术中2例发生硬膜破裂立即修复。单椎板截骨者手术时间91~122 min,平均(111.23±8.93)min;出血量200~350 ml,平均(287.22±11.12)ml;两椎板截骨者手术时间118~165 min,平均(149.28±14.71)min,出血量235~480ml,平均(308.21±11.27)ml。术后出现1例脑脊液漏、1例刀口延迟愈合、2例单侧肢体肌力短时期减弱、1例肺部感染、1例泌尿系感染、1例腰椎不稳、3例腹胀和便秘,上述问题经相应处理治愈,无严重不良后果。术后VAS及ODI评分较术前显著降低,差异有统计学意义(P<0.05)。术后椎管矢状径、横径均较术前明显扩大,差异有统计学意义(P<0.05)。末次随访时,所有患者椎板均骨性融合,未见椎板移位、椎管狭窄及硬膜囊受压。[结论]椎板截骨原位回植小钛板固定术治疗腰椎管狭窄症远期临床疗效满意,此术式较传统椎板减压术具有可重建腰椎后柱完整性及稳定性的优势。

[Objective] To investigate the clinical outcomes of lamina replantation in situ with tiny titanium plate fixation secondary to lamina osteotomy for lumbar spinal stenosis. [Methods] From January 2002 to March 2006, 86 patients underwent lamina replantation with tiny titanium plate fixation after lamina osteotomy for lumbar spinal stenosisin our department. Of them, 43 patients who had complete clinical data in the follow-up period ranged from 10 to 14 years with an average of（11.82±8.65） years were included into this retrospective study. The clinical data including complication were collected, additionally visual analogue scale（VAS） and Oswestry disability index（ODI） score was used, and furthermore the sagittal and transverse diameters of vertebral canal were measured by CT scans to assess the clinical consequences. [Results] All the 43 patients had operation performed smoothly despite the fact that 2 patients got dural tear in operation, which was repaired immediately. The operation lasted（111.23±8.93） mins（ranged from 91 to 122 mins） with blood loss of（287.22±11.12） ml（ ranged from 200 to 350 ml）in the single-lamina osteotomy, whereas（149.28±14.71） min（ranged from 118 to165 min） associated with intraoperative bleeding of（308.21±11.27） ml（ranged from 235 to 480 ml） in the double-lamina osteotomy. In term of early postoperative complications, cerebrospinal fluid leakage happened in 1 patient, delayed incision healing in 1, temporary unilateral lower limb weakness in 2, pulmonary infection in 1, urinary tract infection in 1, lumbar instability in 1 and constipation in 3, which all were cured after proper corresponding treatments without serious consequences. The VAS and ODI scores at 1, 3, and 10 years postoperatively were significantly decreased compared with those before surgery（P〈0.05）, whereas both sagittal and transverse diameters of spinal canal at 3 or 10 years postoperatively were significantly increased compared with those before operation（P〈0.05）. The lamina bony fusion achieved in all the patients without lamina displacement, recurrence of spinal canal stenosis and compression of dural sac in anyone of them at the latest follow up. [Conclusion] The lamina replantation with tiny titanium plate fixation secondary to lamina osteotomy for lumbar spinal stenosis does achievesati sfactory longterm outcomes. It has advantages of reconstruction of the integrity and stability of the posterior column of the lumbar spine over the traditional laminectomy decompression.