椎板成形钢板在脊柱后路全椎板切除减压术中的临床应用

发布时间：2018-04-23 08:58

本文选题：椎板成形钢板 + 椎板切除　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:观察和探讨自主研发的椎板成形钢板在脊柱后路全椎板切除减压术中的临床应用效果。方法:收集我院骨脊柱科自2013.12-2016.4间因颈、胸、腰椎管狭窄行后路全椎板切除减压并应用椎板成形钢板固定的29例患者的临床资料。其中颈椎后纵韧带骨化(C1-7)5例;胸椎黄韧带骨化症(OLF)12例,胸椎后纵韧带骨化(OPLL)6例;腰椎管狭窄症(LSS)6例。男13例,女16例。年龄41-71岁,平均53.1岁。节段分布:C1、2后弓切除联合C3-7后路单开门5例,T1-2椎板切除2例,T1-4椎板切除1例,T1-5椎板切除1例,T2-3椎板切除2例,T2-4椎板切除4例,T5-7椎板切除3例,T5-8椎板切除2例,T7-9椎板切除2例,T10-12椎板切除1例,L1椎板切除3例,L1-2椎板切除3例。术前及术后采用疼痛视觉模拟评分(VAS);使用日本骨科协会(JOA)脊髓功能评分法评估患者术前术后神经功能情况(17分法评估颈椎患者;改良11分法评估胸椎患者;29分法评估腰椎患者),改善率(Recovery rate,RR)作为术后疗效的评价标准。结果:29例手术均顺利完成,均获得随访,随访时间平均18.3个月(11-29个月)。减压节段2-6个,平均3.6个节段。29例患者术后影像学检查未见内固定松动、断裂及相关内固定并发症,减压节段无不稳表现。术后MRI T2加权像上减压范围内的脊髓周围脑脊液信号恢复连续。术中硬脊膜损伤3例,均为硬脊膜骨化与黄韧带粘连严重所致。术后出现脑脊液漏3例。无1例发生硬膜外血肿及切口感染。术前VAS评分平均为6.6±1.1,术后VAS评分平均为2.1±0.6。5例颈椎患者术前平均JOA评分为8.5±1.8,术后平均JOA评分为14.8±1.9,术后功能改善率为(90.1±6.2)%;18例胸椎患者术前平均JOA评分为3.8±1.9,术后平均JOA评分为8.5士1.6,术后功能改善率为(88.9±5.3)%;6例腰椎患者术前平均JOA评分为10.8±1.3,术后平均JOA评分为22.9士2.1,术后功能改善率为(87.4±6.7)%。疗效判定:优20例,良6例,一般3例,差0例,优良率为89.7%(26/29)。结论:对于因颈、胸、腰椎管狭窄症行后路全椎板切除减压术的病例,术中应用椎板成形钢板,操作简便,固定牢靠,有效保护硬脊膜及脊髓,有力避免术后硬脊膜粘连、再骨化、再狭窄等术后并发症,神经功能改善率良好,临床疗效确切。
[Abstract]:Objective: to observe and investigate the clinical effect of laminectomy and decompression with self-developed laminectomy plate. Methods: the clinical data of 29 patients with cervical, thoracic and lumbar spinal stenosis treated by posterior laminectomy and decompression and fixation with laminoplasty plate were collected. There were 5 cases of cervical ossification of posterior longitudinal ligament, 12 cases of ossification of ligamentum flavum in thoracic vertebra, 6 cases of ossification of ossification of posterior longitudinal ligament of thoracic vertebra, 6 cases of lumbar spinal canal stenosis, 6 cases of ossification of ligamentum flavum of thoracic vertebrae and 6 cases of ossification of posterior longitudinal ligament of thoracic vertebra. There were 13 males and 16 females. The average age was 53.1 years. Segmental distribution of C _ 1N _ 2 posterior arch resection combined with C3-7 posterior open door laminectomy in 5 cases with T1-4 laminectomy 2 cases with T1-4 laminectomy 1 case with T1-5 laminectomy 1 case with T2-3 laminectomy 2 cases with T2-4 laminectomy 4 cases with T5-7 laminectomy 3 cases with T5-8 laminectomy 2 cases with T7-9 vertebral laminectomy Laminectomy was performed in 2 cases with laminectomy of T10-12, 1 case with laminectomy of L1, 3 cases with laminectomy of L1-2, and 3 cases with laminectomy. Visual analogue pain score (VASA) was used before and after operation, and spinal cord function was evaluated by JOAA (17 points). A modified 11 score method was used to evaluate thoracic vertebrae and 29 to evaluate lumbar vertebrae with improvement rate of recovery rate (RRR) as the evaluation standard of postoperative curative effect. Results all the 29 cases were followed up successfully. The average follow-up time was 18.3 months, 11 to 29 months. There were 2-6 decompression segments, with an average of 3.6 segments. 29 patients had no internal fixation loosening, fracture and related internal fixation complications, and no instability in decompression segment. The signal intensity of cerebrospinal fluid (CSF) within the range of supraspinal decompression on MRI T 2 weighted imaging was continuous after operation. During operation, 3 cases of dural injury were caused by ossification of dura mater and adhesion of ligamentum flavum. Cerebrospinal fluid leakage occurred in 3 cases after operation. No epidural hematoma or incision infection occurred. The mean preoperative VAS score was 6.6 卤1.1, the postoperative VAS score was 2.1 卤0.6.5 patients with cervical spine, the preoperative average JOA score was 8.5 卤1.8, the postoperative average JOA score was 14.8 卤1.9, the postoperative improvement rate was 90.1 卤6.2%, the preoperative JOA score was 3.8 卤1.9, and the postoperative average JOA score was 3.8 卤1.9. The average preoperative JOA score was 10.8 卤1.3, the postoperative average JOA score was 22.9 卤2.1, and the postoperative functional improvement rate was 87.4 卤6.7%. The results were excellent in 20 cases, good in 6 cases, fair in 3 cases and poor in 0 cases. The excellent and good rate was 89.7% 26 / 29%. Conclusion: for the patients with cervical, thoracic and lumbar spinal stenosis undergoing posterior laminectomy and decompression, laminectomy and decompression with laminectomy is simple, reliable, effective to protect the dura mater and spinal cord, and to avoid postoperative epidural adhesions. The postoperative complications, such as ossification and restenosis, the improvement rate of nerve function is good, and the clinical curative effect is definite.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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