联合组织瓣植回椎管扩大成形术治疗退变性椎管狭窄症疗效分析.docVIP

联合组织瓣植回椎管扩大成形术治疗退变性椎管狭窄症疗效分析 　　【摘要】 目的：探讨椎板及棘上-棘间韧带联合组织瓣植回术治疗退变性腰椎管狭窄症的技术要点和疗效。方法：选取66例患者，男25例，女41例，年龄53～81岁，平均67岁。将部分腰背筋膜、棘上韧带、棘间韧带及椎板上骨膜保留，于病变节段下一椎间隙切断棘上-棘间韧带，用低速电动磨钻或骨凿，在关节突关节内侧，由下向上沿椎板矢状位全层楔形截骨，直至整个病变节段，向上牵开椎板及棘上棘间韧带，常规进行椎管减压，棘突椎板联合组织瓣植回术。结果：66例均得到随访，最长7年，最短8个月，平均46个月。总优良率89.3%。结论：本术式增加椎管矢状径，扩大椎管容积，有利于减压。椎板及棘上-棘间韧带联合组织瓣植回形成生理管性结构，恢复了脊柱三柱的稳定性，既防止硬膜与组织间瘢痕组织增生形成的医源性椎管狭窄，又防止脊柱后柱失稳。显露范围广、椎管减压彻底，使椎管重新成形，有效的预防术后脊柱不稳、顽固性腰痛等并发症。 　　【关键词】 椎板及棘上-棘间韧带联合组织瓣植回； 椎管成形； 退变性腰椎管狭窄症 　　The Effect Analysis of Combined Tissue Flap Grafting to Spinal Canal Plasty in the Treatment of Degenerative Enlargement of Spinal Canal Stenosis/HOU Bin.//Medical Innovation of China，2015，12（04）：143-146 　　【Abstract】 Objective：To investigate the laminae and spinous-interspinous ligament combined tissue flap grafting technique points back to the surgical treatment of degenerative lumbar spinal canal stenosis and curative effect.Method：66 cases were selected， male 25 cases， female 41 cases，53-81 years old， average 67 years old.Part of the lumbodorsal fascia，supraspinal ligament，interspinal ligament and periosteum retention of vertebral lamina were reserved， in lesion segment next vertebra clearance off spine-interspinal ligament， with low speed electric drill or chisel， in the medial facet， from the bottom to the top along the vertebral sagittal full-thickness wedge osteotomy， until the entire lesion segment， to pull the lamina and the supraspinous and interspinous ligaments， routine decompression， spinous process and lamina combined tissue flap grafting back surgery.Result：66 cases were followed up， the longest 7 years， the shortest 8 months， average 46 months.The total excellent rate was 89.3%.Conclusion：This technique increases the sagittal diameter of spinal canal， expanding vertebral canal volume， is conducive to reducing.Lamina and spinous-interspinal ligament combined tissue flap grafting to form physiological tube structure， restore stability of the spine and three pillars， both to prevent i