【摘要】 目的:测量椎板的相关参数,探索用骨刀安全快捷有限开窗治疗腰椎间盘突出症的方法。方法:对100套成年人腰椎(L1～S1)干燥骨标本椎板结构进行测量,并根据术前患者X线和CT片测量的相关数据,设计上下椎板的切骨线和切骨方向。骨刀切入深度参考干燥骨测量的相关参数。用不同型号的锋利骨刀在椎板间有限开窗摘除间盘髓核组织对228例病人进行了手术治疗。结果:椎板上下缘的厚度为3.2~14.4mm;上下缘中部中点的厚度为3.5~10.9mm;腰椎双侧关节突间隙间距离为22.0~56.5mm;腰骶椎椎板夹角上缘为60°~115°,下缘为30°~150°。228例患者手术操作时间15～30min,平均20min。失血10～70ml,平均45ml。无骨刀损伤神经根和硬脊膜病例。192例获得18～78个月,平均41.6个月随访,优158例,良28例,差6例,优良率95.8%。结论:腰椎椎板结构相关参数自L1至S1有一定变化规律,为个体化较安全的手术操作提供了参考值。但个体化手术方案设计应主要依靠术前影像学测量结果。骨刀有限开窗的手术方法治疗腰椎间盘突出症是安全的,它能够简化手术程序,省时,减少手术损伤和失血。更多还原

【Abstract】 Objective:Measurring the correlation parameters of the laminae construction to evaluate the method of safe and rapid operation to treat lumbar disc heniation by using osteotome finite fenestration.Method:One-hundred dry samples of the laminae(L1～S1)construction of human cadaveric lumbar spine were measured with lamina’ s thickness,interval of both lumbar articular spaces,intersecting angle of both laminaes.The line and direction of osteotomy was designed individually based on preoperative radiographic measure-ments.The depth of osteotomy based on the correlation parameters of the laminae construction.Using different model osteotome finite fenestrations were made to removal of nucleus pulposus for228cases.Result:The lami-na’s thickness of superior and inferior margin was3.2~14.4mm.The thickness of intermediate point was3.5~10.9mm.The interval of both lumbar articular spaces was22.0~56.5mm.The intersecting angle both laminaes of superior margin was60°~115°,the inferior margin’s was30°~150°.The228cases’s average operation time was20min(15～30min).The average blood loss was45ml(10～70ml).there were no cases of the nerve root and du-ral sac damaged.192cases were follow-up for an average41.6month(18～78month).158cases were excellent,28cases were good,6cases were poor.95.8%was fine.Conclusion:The change of correlation parameteres of the laminae construction is regular from L1to S1,this provide the reference data for operation.But the individ-ual operation program is based on the results of preoperative radiographic measurements.This method is safe,and able to simplify operative processes,save time,and reduce operative lesion and blood loss.更多还原