经椎板间孔减压棘上与棘间韧带重建治疗腰椎管狭窄症

为解决由于术中破坏了脊柱后部结构和过多切除椎板引起的医源性腰椎不稳和椎管狭窄，设计了一种“经椎板间孔减压棘上棘间韧带重建”术式，用此术式治疗３１例腰椎管狭窄患者，术后随访１６个月以上１９例，摄腰椎屈曲和伸展位片，无１例椎体间相对移位≥３ｍｍ。按日本骨科学会下腰痛疗效评价标准，优良率为１００％。本术式改变了传统的手术路径，保证了棘上和棘间韧带的血液供应，且术野开阔，切除黄韧带通过椎板间孔解除致压因素，减少了“椎板切除膜”形成的空间，将棘上和棘间韧带吻合于原切断处，保护了脊柱的前屈刚度，对脊柱稳定起到了重要作用。

Treatment of lumbar vertebral canal stenosis by decompression of the vertebral laminae and reconstruction of interspinous and supraspinous ligament

In order to solve the problem of operation resulted in iatrogenic instability of lumbar vertebrae and vertebral canal. stenosis ,an operative method was designed to decompress the vertebral laminae and reconstruction of interspinous and supraspinous in clinical practice. It altered the traditional operative approach and assured the blood supply of interspinous and supraspious ligament and broadened the operative field. The cutting of the flaval ligament and getting rid of the pressing factors resduced the space formed by postlaminectomy membrane. The anastomosing interspinous and supraspious ligament protected the posterior ligament which play an importance role in spinal stability. 31 cases were treated by this method , 19 of them were followed up more than 16 months. According to the assessment of JOA for low-back pain , the effective rate was 100%.Author's address(Department of Spine Surgery ,Wendeng City Orthopadic Hospital,Shandong, 264400)