摘要
[目的]探讨棘突椎板韧带复合体回植腰椎管成形在儿童选择性脊神经后根切断(SPR)术中的应用价值及术后转归。[方法]回顾性分析2007年7月～2009年12月本院腰椎SPR手术的脑瘫患儿36例68椎。手术时平均年龄6.5岁。椎管成形方法为棘突椎板棘上韧带复合体整块取出后纵劈开大,原位覆盖回植,丝线固定并重建棘上韧带连续性。术后随访患者症状和影像学评估腰椎稳定性、回植椎板骨融合及转归。[结果]随访平均32个月。术后患者均无腰痛。双下肢肌张力级别由术前平均2.2±0.6降至术后平均0.5±0.2,差异有统计学意义(P<0.05)。腰椎X线片19例未见明显异常;16例可见腰椎术后改变;12例腰椎屈伸位相术前和随访时比较未见明显变化。腰椎CT,椎管形态均基本完整,回植椎板融合率(85.3%),吸收率(61.8%)二者之间呈统计学负相关关系。2例腰椎MRI可见回植椎板部分缺失,硬膜囊无受压,棘上韧带连续。[结论]棘突椎板韧带复合体回植腰椎管成形应用于儿童SPR术可较好重建腰椎稳定性,随访2年以上有回植椎板吸收现象,但对腰椎发育无明显影响,残存椎板与周围软组织共同对椎管内神经起保护作用。
[ Objective ] To explore the application and clinical outcome of lumbar laminoplasty for selective posterior rhizotomy （SPR） in children. [ Methods] Sixty -eight vertebra of cerebral pulsy in 36 cases of SRR were analyzed retrospectively from July 2007 to December 2009 , with male 23 cases, female 13 cases. Mean age was 6. 5 years at the operation. Lumbar laminoplasty methods were spinous process, lamina and supraspinal ligament complex were taken out as whole piece and widen by split, and were replanted in situ , fixed with silk, reconstructed for supraspinal ligament continuity after SPR. All patients were followed up with symptoms, lumbar X - ray, CT or MRI, and were evaluated for the spinal canal morphology, lumbar spinal stability, replanted lamina bone fusion and outcome. [ Results ] The average follow - up period was 32 months. Postopera- tive patients showed no back pain. The muscle tone of lower extremity decreased postopratively, the difference was statistically significant （ P 〈 0.05 ） . The lumbar X - ray in 19 cases showed no obvious abnormity, in 16 cases showed good spinal alignment, but visible lurnbar postoperative change. Twelve cases of lumbar X - ray of flexion and extention phase showed no change between preoperation and follow - up. Lumbar CT in all cases showed the spinal canal morphologymainly integrity, with no stenosis and compression. Fusion rate was 85.3%, absorption rate was 61.8% , the relationship between the two index showed nega- tive correlation statistically. Lumbar MRI in 2 cases showed lamina partial absent at local section of surgery, no dural compression, and continuous supraspinal ligament. [ Conclusion ] Lumbar laminoplasty with replantation of spinous process, lamina and supraspinal ligament complex could reconstruct the lumbar spinal stability in SPR. Replanted lamina absorbing phenomenon were observed after 2 years of follow - up, but there was no significantly influence to the development of the lumbar spine. Residual lamina and soft tissue around the spinal canal could protect neural tissue.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2012年第13期1178-1181,共4页
Orthopedic Journal of China
基金
中央级公益性科研院所基本业务专项(2011CZ-10)
北京市科技新星计划(2007B070)
关键词
椎管成形
腰椎
儿童
选择性脊神经后根切断术
脑瘫
laminoplasty, lumbar, children, selective posterior rhizotomy, crerbral palsy
