本文選題：椎板成形鋼板 + 椎板切除�。� 參考：《山西醫(yī)科大學》2017年碩士論文

【摘要】：目的:觀察和探討自主研發(fā)的椎板成形鋼板在脊柱后路全椎板切除減壓術中的臨床應用效果。方法:收集我院骨脊柱科自2013.12-2016.4間因頸、胸、腰椎管狹窄行后路全椎板切除減壓并應用椎板成形鋼板固定的29例患者的臨床資料。其中頸椎后縱韌帶骨化(C1-7)5例;胸椎黃韌帶骨化癥(OLF)12例,胸椎后縱韌帶骨化(OPLL)6例;腰椎管狹窄癥(LSS)6例。男13例,女16例。年齡41-71歲,平均53.1歲。節(jié)段分布:C1、2后弓切除聯(lián)合C3-7后路單開門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。術前及術后采用疼痛視覺模擬評分(VAS);使用日本骨科協(xié)會(JOA)脊髓功能評分法評估患者術前術后神經(jīng)功能情況(17分法評估頸椎患者;改良11分法評估胸椎患者;29分法評估腰椎患者),改善率(Recovery rate,RR)作為術后療效的評價標準。結果:29例手術均順利完成,均獲得隨訪,隨訪時間平均18.3個月(11-29個月)。減壓節(jié)段2-6個,平均3.6個節(jié)段。29例患者術后影像學檢查未見內(nèi)固定松動、斷裂及相關內(nèi)固定并發(fā)癥,減壓節(jié)段無不穩(wěn)表現(xiàn)。術后MRI T2加權像上減壓范圍內(nèi)的脊髓周圍腦脊液信號恢復連續(xù)。術中硬脊膜損傷3例,均為硬脊膜骨化與黃韌帶粘連嚴重所致。術后出現(xiàn)腦脊液漏3例。無1例發(fā)生硬膜外血腫及切口感染。術前VAS評分平均為6.6±1.1,術后VAS評分平均為2.1±0.6。5例頸椎患者術前平均JOA評分為8.5±1.8,術后平均JOA評分為14.8±1.9,術后功能改善率為(90.1±6.2)%;18例胸椎患者術前平均JOA評分為3.8±1.9,術后平均JOA評分為8.5士1.6,術后功能改善率為(88.9±5.3)%;6例腰椎患者術前平均JOA評分為10.8±1.3,術后平均JOA評分為22.9士2.1,術后功能改善率為(87.4±6.7)%。療效判定:優(yōu)20例,良6例,一般3例,差0例,優(yōu)良率為89.7%(26/29)。結論:對于因頸、胸、腰椎管狹窄癥行后路全椎板切除減壓術的病例,術中應用椎板成形鋼板,操作簡便,固定牢靠,有效保護硬脊膜及脊髓,有力避免術后硬脊膜粘連、再骨化、再狹窄等術后并發(fā)癥,神經(jīng)功能改善率良好,臨床療效確切。
[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 鹵1.1, the postoperative VAS score was 2.1 鹵0.6.5 patients with cervical spine, the preoperative average JOA score was 8.5 鹵1.8, the postoperative average JOA score was 14.8 鹵1.9, the postoperative improvement rate was 90.1 鹵6.2%, the preoperative JOA score was 3.8 鹵1.9, and the postoperative average JOA score was 3.8 鹵1.9. The average preoperative JOA score was 10.8 鹵1.3, the postoperative average JOA score was 22.9 鹵2.1, and the postoperative functional improvement rate was 87.4 鹵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.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.3

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