椎板开门回植成形的解剖学和生物力学研究

目的 :探讨椎板开门回植成形在SAR和SPR手术中的应用价值。方法 :在 12具胸腰段脊柱标本上模拟手术椎板单开门、内板及棘突纵开槽、横行掰开回植成形 ,分别测量成形前后的椎管横、矢径。选 12具胸腰椎椎板成形的的标本 ,用MTS 85 8实验机进行生物力学测试。并将此椎板开门回植成形术应用于临床 2 5例SAR和SPR手术中。结果 :成形术后的椎管内径均略大于术前。成形术后的椎板的所能承受垂直压应力平均为 78.5 4kg ,远远大于仰卧位时脊柱所需要承受的压应力。临床随访平均 2年 6个月 ,临床效果良好 ,无脊柱不稳和椎管狭窄的症状、体征和影像学依据。结论 :椎板开门回植成形既满足了SAR和SPR手术的显露要求 ,保持了脊柱的稳定性 ,又达到了微创效果 ,值得提倡。

Applied anatomy and biomechanical study of split-and-restoration of vertebral lamina

Objective: To evaluate the clinical significance of the split-and-restoration of vertebral lamina in SAR and SPR. Methods: 12 thoracic-lumber vertebral specimens were operated with split-and-restoration. Their internal diameters were measured before and after the operation, and their biomechanical functions were measured on MTS-858 after operation. Furthermore, the technique of split-and-restoration was applied on 25 clinical cases of SAR and SPR. Results: The internal diameter of vertebral canal became larger after operation. The average pressure that post-operational can load is 78.54kg, greatly larger than needed pressure. Indicated by clinical follow-up of 30 months, there are no evidences of spinal instability and spinal canal stenosis. Conclusion: Not only meet the requirement of SAR and SPR, but also keep the stability of spine and get an effect of micro-trauma, split-and-restoration of vertebral lamina is a valuable technique.