人工椎板基础与临床研究

背景：椎板切除后可破坏脊柱后柱结构,部分患者在椎板缺损区形成大的瘢痕组织与硬膜及神经根粘连,牵扯、压迫神经,严重影响脊柱手术的远期效果。目的：综合分析人工椎板在修复缺损椎板,防止椎板切除后并发症发生方面的研究进展和现状。方法：由第一作者应用计算机检索重庆维普数据库(1996-01/2009-01)、清华同方数据库(2000-01/2009-01)及PubMed数据库(1996-01/2009-01)有关椎板切除后再狭窄、术后粘连、人工椎板研究和实验等方面的文献,中文检索词为“人工椎板,椎板切除后,术后粘连”,英文检索词为“artificial vertebral lamina,laminectomy”。排除重复性研究,共保留22篇归纳总结。 结果与结论：人工椎板对椎板切除后所造成的继发性瘢痕粘连,导致压迫硬膜囊与神经根,形成椎板切除后再狭窄,以及造成的脊柱不稳有预防作用。但是人工椎板在材料及设计上有待进一步改进,理想的材料应该是能很好的发挥屏障和保护作用,而又无不良作用,并且随着时间的延长诱导新生骨生成以达到骨性融合,目前的技术、方法还达不到上述理想的效果。关键词：人工椎板;椎板切除;再狭窄;粘连;并发症doi:10.3969/j.issn.1673-8225.2012.13.040

Basic and clinical research of artificial lamina

BACKGROUND: Laminectomy can damage the spinal column structure, large scar tissue formation can be seen in some patients which adhere with the dura mater and nerve root that lead to the involve and compression of nerves, and finally, it can seriously affect the long-term effects of spinal surgery. OBJECTIVE: To comprehensive analysis the research progress and state of artificial lamina in the repair of lamina defect and the prevention of the occurrence of postoperative complications. METHODS: A computer-based online search of Chongqing Weipu database (1996-01/2009-01), Tsinghua Tong Fang database (2000-01/2009-01) and PubMed database (1996-01/2009-01) was preformed for the articles about the restenosis after laminectomy, postoperative adhesions, artificial lamina research and experiment with the key words of “artificial lamina, laminectomy, postoperative adhesions” in Chinese and “artificial vertebral lamina,laminectomy” in English. The repetitive researches were excluded and a total of 22 articles were included to review. RESULTS AND CONCLUSION: Artificial lamina has the preventive effect on the secondary scar adhesion after laminectomy, dural sac and nerve root, restenosis after laminectomy and spinal instability. But the artificial lamina needs further improvement in materials and design, as the ideal material can play the barriers and protective effect well with no adverse effect, and with the time prolonged, the ideal material can induce the bone regeneration in order to achieve bone fusion. The current technology and methods can not reach the effect above.