腰椎管扩大减压术中保留棘突韧带复合体的优势与问题

Preservation of the spinous process ligament complex in expanded decompression of lumbar spinal canal: advantages and disadvantages

背景:棘突韧带复合体对维持脊柱稳定性及保护椎管后方结构具有重要作用。传统的腰椎管扩大减压术需将后方组织完全切除,术后常导致出血多、脑脊液漏、感染、椎体滑脱、顽固性腰腿痛、僵硬等并发症。随着对传统术式的不断改进和改良,越来越多的学者青睐于在腰椎管扩大减压术中保留棘突韧带复合体,并在此基础上形成多种改良术式。目的:总结腰椎管扩大减压术中保留棘突韧带复合体不同术式的特点及相关手术问题。方法:应用计算机检索PubMed、万方、知网数据库中从1983年1月至2018年6月关于在腰椎管扩大减压术保留棘突韧带复合体的文章。英文检索词为"Laminectomy,Spinous process ligament complex,lumbar expandeddecompression",中文检索词"腰椎保留棘突韧带复合体,腰椎管扩大减压",排除与研究内容无关和内容重复的文章,保留32篇文章进行综述。结果与结论:(1)随着对传统腰椎后路术式的不断改进,腰椎管扩大减压术中保留棘突韧带复合体的术式逐渐受到推崇;(2)目前其术式主要包括保留棘突韧带复合体的腰椎管扩大减压术、保留一侧肌肉韧带复合体的腰椎管扩大减压术及椎板棘突韧带复合体回植的腰椎管扩大减压术3大类,每一大类又衍生出几种特殊术式,每种术式均具有其自身特点与相关手术问题;(3)对不同的患者,应严格把握其手术指征,选择最适合的术式进行手术治疗,对改善其疗效及预后至关重要。

BACKGROUND: Spinous process ligament complex plays an important role in maintaining the stability of the spine and protecting the posterior structure of the spinal canal. Traditional expanded decompression of lumbar spinal canal requires complete resectio n of the posterior bone and soft tissue, which often leads to complications such as hemorrhage, cerebrospinal fluid leakage, infection, vertebral spondylolisthesis, intractable low back pain and stiffness. With the improvement and development of traditional procedures, s cholars prefer to the preservation of the spinous process ligament complex in lumbar decompression, and then develop various advanced surgical techniques. OBJECTIVE: To summarize the features and problems of different improved techniques about the spinous process ligament complex in expanded decompression of lumbar spinal canal. METHODS: A computer-based online search was conducted in PubMed ,WanFang and CNKI databases from January 1983 to June 2018 to screen the relevant articles regarding the preservation of the spinous process ligament complex in the posterior lumbar spinal canal enlargement using the keywords of “laminectomy, spinous process ligament complex, lumbar expanded decompressionl” in English and Chinese, respectively. The irrelevant and duplicate articles were excluded, and finally 32 eligible articles were reviewed. RESULTS AND CONCLUSION:(1) With the continuous improvement and development of traditional surgery, retaining the spinous process ligament complex in expanded decompression of lumbar spinal canal is more and more advocated.(2) The advanced techniques mainly have three major categories, including expanded decompression of lumbar spinal canal with preserved spinous process ligament complex, expanded decompression of lumbar spinal canal with retaining one side of the muscle ligament complex, and the expanded decompression of lumbar spinal canal with replantation after spinous process resection. Some characteristic techniques are derived, and each technique has its features and related surgical problems.(3) We should strictly grasp the indications and select the optimal surgical methods for different patients, which is essential to improve the efficacy and prognosis.