全椎板切除后椎板重建治疗腰椎管狭窄症

目的:观察全椎板切除椎管减压内固定术后采用硬膜外植骨重建椎板方法治疗腰椎管狭窄症的早期(术后3个月)及中期(术后＞1年)疗效.方法:选择22例中重度退行性腰椎管狭窄患者行全椎板切除椎管减压内固定术,男12例,女10例;年龄55～76岁,平均65.8岁;病变节段为L3-S1,包括单节段(6例)、双节段(13例)、三节段(3例).全椎板切除后在切除椎板间硬膜外植骨重建椎板.随访时间1～3年,分别在术前、术后3个月及末次随访时采用JOA评分从主观症状、临床体征、日常活动受限情况及膀胱功能等方面对疗效进行评价,并通过影像学检查测量椎管矢状径变化.结果:22例患者均获随访,术前、术后3个月及末次随访时JOA下腰痛评分分别为(5.3±1.6)、(23.2±2.0)、(22.9±2.4)分;术后3个月优18例,良3例,可1例;末次随访优17例,良3例,可2例.狭窄节段术前椎管矢状径为(6.8±0.9) mm,术后3个月为(17.6±2.5) mm,末次随访时为(16.9±1.8) mm.经统计学检验,JOA评分术后3个月与术前比较,差异有统计学意义(P＜0.05);末次随访与术前比较,差异也有统计学意义(P＜0.05);术后3个月和末次随访疗效比较无统计学差异(P＞0.05).椎管矢状径改变椎板重建术后3个月与术前比较有统计学差异(P＜0.05),而椎板重建术后3个月与末次随访时比较无统计学差异(P＞0.05).影像学变化:末次随访时的CT片示椎管无狭窄,神经根、硬膜囊无压迫,椎板重建后骨质已大片融合,未发现明显的骨质吸收,内固定无松动及断裂情况.结论:椎板切除后椎板间植骨重建术治疗腰椎管狭窄症可以同时达到充分减压和脊柱生物力学稳定,能有效预防术后瘢痕压迫和粘连形成椎管再狭窄,中早期疗效满意.

Clinical analysis of vertebral laminae reconstruction after laminectomy and pedicle screw fixation in treating lumbar spinal stenosis

Objective: To observe the curative effects of vertebral laminae reconstruction after laminectomy and pedicle screw fixation for the treatment of lumbar spinal stenosis in early(at the 3rd months after operation) and metaphase(at the more than 1 year after operation). Methods: Twenty-two patients with lumbar spinal stenosis were treated by vertebral laminae reconstruction after laminectomy and pedicle screw fixation,there were 12 males and 10 females,the age was from 55 to 76 years with an average of 65.8 years,including single segment(6 cases),double segments(13 cases) and three segments (3 cases) of L3-S1. The follow-up period was for 1-3 years,preoperative and postoperative(at the 3rd months after operation and last follow-up) to assess the subjective symptoms,physical signs,the limit of daily activities and bladder function according to JOA scoring;and observe saggital diameter measurement and radiological changes through X-ray and CT. Results: All the patients were followed up,the JOA scoring were respectively 5.3±1.6,23.2±2.0,22.9±2.4 before operation and after operation (at the 3rd after operation and last follow-up);at the 3rd months after operation,18 cases obtain excellent results,3 good,fair 1,and at the last follow-up,17 cases obtain excellent results,3 good,fair 2,there was no significant difference between two postoperative periods(u=0.413,P<0.05). The mean sagittal diameter of narrow segment was respectively(6.8±0.9),(17.6±2.5),(16.9±1.8) mm before operation,at the 3rd months after operation and the last follow-up. Through statistics processing,there was significant different comparing JOA scoring at 3 months after operation,last follow-up with preoperative(P<0.05). There was significant difference of vertebral canal sagittal diameter between at the 3rd months after operation and before operation (t=35.116,P<0.01);there was no significant difference between at the 3rd months after operation and last follow-up (t=1.814,P>0.05). The CT examination of last follow-up showed the vertebral canal have no stenosis,the dural sac and nerve roots have no compression,the rebuilt vertebral laminae have fused well,the graft bone are no absorbed and the fixation have no failure. Conclusion: Treatment of lumbar spinal stenosis with vertebral lamina reconstruction after vertebral laminectomy and pedicle screw fixation can obtain satisfactory results in early and metaphase. The method had advantages of decompression thoroughly and fixation solidly,and could prevent vertebral canal restenosis causing by nerve oppression of the postoperative scar and nerve adhesion.