椎板减压钛网椎管成形后路融合内固定术治疗腰椎管狭窄症

目的:探讨椎板减压钛网椎管成形后路融合内固定术在腰椎管狭窄症中的临床应用效果.方法:选择32例退行性腰椎管狭窄症患者行椎板减压钛网椎管成形后路融合内固定术,测量术前、术后1年及术后最后1次随访时的腰椎管面积,同时记录患者主观对腰腿痛的Greenough和Fraser评分,进行统计学分析.结果:所有患者均获得随访,平均随访3.2(2.5～6)年.狭窄节段钛网椎管成形前横截面积为正常横截面积的(62.8±11.2)%,术后1年面积为(120.2±5.8)%,最后1次随访时为(123.6±9.2)%.术前Greenough和Fraser评分为(25.7±6.9)分,术后1年为(68.1±2.9)分,最后1次随访时为(68.7±8.7)分.椎管横截面积、Greenough和Fraser评分术后1年与术后最后1次随访时比较差异无显著性(P>0.05),但与术前比较差异均有显著性(P<0.01).结论:椎板减压钛网椎管成形后路融合内固定术治疗腰椎管狭窄症能够在恢复椎管形状、免除马尾及神经根压迫的同时,进行植骨融合,重建脊柱的稳定性,有利于保持手术疗效,值得临床推广应用.

Treatment for spinal stenosis with titanium rete vertebral canals reconstruction and bone allograft after laminectomy

Objective：To investigate the clinical efficacy of titanium rete vertebral canals reconstruction and bone allograft after laminectomy for spinal stenosis. Methods：32 cases of spinal stenosis were selected and treated with decompressive laminectomy and titanium rete canaloplasty. The horizontal view of spinal canal of preoperation,one year after operation,and in the last follow-up was measured, and the patients＇ subjective feeling of back and leg pain was evaluated with Greenough and Fraser＇ s score system respectively. The data were compared with statistical analysis. Results：All the cases were followed-up,the average followed-up time was 3.2 years ranged from 2.5-6 years. The transverse area of the stenosed canal was （62.8±11.2）%, （120.2±5.8）% and （123.6±9.2）% of the normal part before operation, one year after operation and in the last following-up respectively. The Greenough and Fraser＇s scores were （25.7±6.9）, （68.1±2.9）, （68.7±8.7） at the corresponding time. There was significant difference between the data of preoperation and postoperation （P〉 0.05）, but there was no significant difference between the two postoperative data （P〈0.01）. Conclusion：Titanium rete vertebral canals reconstruction and bone allograft can avoid the nerve root and dura mater compression after laminectomy, do spinal fusion and reconstruct stability of the spine at the same time. It can maintain the good effect after operation, worthing popularizing in clinical application.