【作者】 王正雷； 高吉昌； 张承敏； 晁民； 王仑； 张洁； 张文进； 孙鹏； 万高义；

【Author】 WANG Zheng-lei GAO Ji-chang ZHANG Cbeng-min. Department of Or- thopaedic,211 Hospital,Harbin China 150080

【机构】 解放军第211医院全军骨科中心； 黑龙江省呼兰县杨林镇医院骨科； 解放军第69师医院骨科；

【摘要】 目的:采用腰椎板上1/2切除椎管成形术治疗腰椎管狭窄症86例。方法:手术在硬膜外麻下进行,病人俯卧于手术台上,摇起后使床架形成鞍状,病人腹部悬空。正中纵行切口,根据需要可由 L₂至 S₂,显露棘突、椎板、关节突、黄韧带、棘间韧带、棘上韧带。保留棘上韧带、棘间韧带,切除黄韧带。以 L₃狭窄为例,先切除 L₃上部1/2椎板,侧方达椎弓根、上关节突, 形成一方形窗,探查脊髓、神经根及神经根管,再探查腰间盘有无突出及椎体后缘有无增生,有间盘突出行切除术,有神经根及神经根管,有神经根管狭窄可切除部分关节突内侧骨质、关节囊、黄韧带,椎体后缘增生也可切除,充分扩大神经根管。将 L_3～4黄韧带切除,L₃椎板下1/2部行潜式切除椎板内侧皮质,刮薄后仅留外层骨皮质,以充分扩大矢状径,若横径小,同法可处理 L_4、5、S₁。充分减压后,可见脊髓压迫解除膨胀良好,色泽正常,神经根充分减压,窗口处取全层脂肪或明胶海绵充填空隙,依次缝合肌层、筋膜、皮肤。术后卧位,术后2天行下肢抬高训练,10 天后拆线,腰围支持下下床活动。结果:86例中随访4年57例,优良率94%,无严重合并症。结论:腰椎板上1/2切除+椎管弓形成形术能有效治疗腰椎管狭窄症,本术式优点:1.充分扩大椎管,包括神经根管;2.不破坏脊柱的稳定性;3.不再形成新的压迫;4.保持原腰椎活动范围。更多还原

【Abstract】 Objective:Using half-laminectomy and arcuate-shaped plastic operation of the spi- nal canal to treat lumbar spinal canal stenosis in 86 patients.Method:The vertebral lamina of spinal canal stenosis,pedide of vertebral arch and yellow ligament were sectioned.The vertebral lamina inter- na of spinal canal stenosis were removed in laminectomy curet.The arcuate-shaped of vertebral lami- na externa of spinal canal stenosis to be shaped.The transverse diameter of vertebral canal was suffi- eiently enlarged.The medial surface of articular process,joint capsule,yellow ligament and hypertrophy of vertebral body were removed in patients with neural root tube stenosis.Result:86 patients have been operated upon with the good and excellent rates were 94%.All of patients were followed-up years.Conclusion:The method of half-laminectomy and arcuate-shaped plastic of the spinal canal in treatment lumbar spinal canal stenosis was better than others.The charactoristies of this operation were:1.The spinal canal was sufficiently enlarged,including the nerve root canal.2.The stability of the spine was not jeopardized.3.The original range of movement of the spine was maian- tined.4.Secondary stenosis if prevented.更多还原