椎板切除潜行减压椎板回植治疗腰椎管狭窄的疗效观察

发布时间：2018-06-01 06:48

本文选题：腰椎管狭窄 + 椎板截骨　；参考：《华北理工大学》2017年硕士论文

【摘要】：目的通过临床及影像学评价椎板切除潜行减压椎板回植术治疗腰椎管狭窄的疗效及再植椎板两种固定材料的差异。方法选取唐山二院脊柱一科2014年8月至2016年1月期间,采用椎板切除潜行减压椎板回植输治疗的73例腰椎间盘突出症伴腰椎管狭窄及腰椎管狭窄症患者,47例椎板回植后采用丝线固定,26例采用钛板固定。运用JOA、腰腿痛VAS评分,评价丝线固定及钛板固定临床效果及对比两种固定对临床效果的影响。影像学方面随访通过腰椎X线正侧位、CT、屈伸动力位观察术后椎管减压情况、椎板再植愈合程度及术后硬膜外瘢痕情况,对比两种固定材料术后影像学表现的差异性。结果73例患者中,69例患者获得临床疗效随访,包括椎板再植丝线固定45人,随访时间18.2个月,椎板再植钛板固定24例,随访时间14.4个月。丝线固定术后JOA评分升高、腰腿痛VAS评分降低,与术前相比差异有统计学意义(P0.05),末次随访优良率达88.9%,钛板固定术后JOA评分升高、腰、腿痛VAS评分降低,差异有统计学意义(P0.05),末次随访优良率为91.7%。椎板再植丝线固定与钛板固定术后相同时间点对比,钛板固定术后3个月时JOA高于丝线固定,而3个月、6个月腰痛VAS低于丝线固定(P0.05),钛板固定优于丝线固定。60例患者获得影像学随访,丝线固定37人,钛板固定23人。丝线固定中再植椎板1例未愈合,6例为不全愈合,其余全部正常愈合,愈合时间为6-12月。钛板固定中除1例因超声骨刀截骨导致内陷外其余全部正常愈合,愈合时间为3-6个月。愈合后截骨前缘未见过度增生产生新的压迫和骨痂向椎管内突出,截骨前缘光滑,硬膜囊充盈膨胀良好。椎管失状径、横径扩大。修复的椎管有效的阻止了椎管外瘢痕组织向椎管内移位。末次随访无腰痛加重及过伸过屈位无不稳的发生。结论1椎板切除潜行减压椎板回植是治疗腰椎管狭窄一种有效术式,能解除压迫改善临床症状,同时修复了腰椎后部结构,有效的防止了腰椎不稳及硬膜外瘢痕粘连等并发症。2椎板再植后钛板固定具有更可靠的牢固性,有利于再植椎板的稳定及愈合。
[Abstract]:Objective to evaluate the effect of laminectomy with decompression and laminectomy in the treatment of lumbar spinal canal stenosis and the difference of two kinds of fixation materials. Methods from August 2014 to January 2016, the spine of the second Hospital of Tangshan was selected. Forty-seven patients with lumbar disc herniation with lumbar spinal canal stenosis and lumbar spinal canal stenosis were treated with laminectomy, decompression and laminectomy, and 26 patients were treated with titanium plate fixation after laminectomy. The clinical effects of wire fixation and titanium plate fixation were evaluated by using VAS score of JOAand lumbago and leg pain. Imaging follow-up was performed to observe the decompression of the spinal canal, the healing degree of laminar replantation and the epidural scar after operation by CT, flexion and extension dynamic position of lumbar vertebrae. The difference of imaging findings between the two kinds of fixation materials was compared. Results among 73 cases, 69 cases were followed up, including 45 cases of laminae replantation and wire fixation. The follow-up time was 18.2 months, 24 cases were fixed with titanium plate, and the follow-up time was 14.4 months. The JOA score increased and the VAS score of lumbago and leg pain decreased after silk thread fixation. The difference was statistically significant (P 0.05). The excellent and good rate of the last follow-up was 88.9%. The JOA score increased and the VAS score of lumbar and leg pain decreased after titanium plate fixation. The difference was statistically significant (P 0.05), and the excellent and good rate of the last follow-up was 91.7%. Compared with the same time points after laminectomy, the JOA of laminar replantation was higher than that of filamentous fixation at 3 months after laminectomy. In 3 months and 6 months, the VAS of lumbago was lower than that of wire fixation (P 0.05), and titanium plate fixation was superior to wire fixation in 60 cases. 37 cases were fixed with wire and 23 cases were fixed with titanium plate. In the filamentous fixation, 1 case of unhealed laminae was not healed completely, the rest healed normally, and the healing time was 6 months to 12 months. The healing time of titanium plate fixation was 3-6 months. No new compression and callus protruding into the spinal canal were found in the anterior edge of the osteotomy after healing. The anterior edge of the osteotomy was smooth and the dural sac filled and expanded well. The spinal canal is lost and the transverse diameter is enlarged. The repaired spinal canal effectively prevents the extramedullary scar tissue from moving into the spinal canal. No increase in low back pain and no instability in extension and flexion at the last follow-up. Conclusion 1 Laminectomy with decompression is an effective method for the treatment of lumbar spinal canal stenosis. It can relieve compression and improve clinical symptoms, and at the same time, it can repair the posterior structure of lumbar vertebrae. Effective prevention of complications such as lumbar instability and epidural scar adhesion. 2. Titanium plate fixation after lamina replantation is more reliable and reliable, which is beneficial to the stability and healing of the replanted lamina.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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