白金柱;洪毅;王一昕;张军卫;唐和虎;姜树东;李想;王方永;

• 1:中国康复研究中心北京博爱医院脊柱外科
• 2:首都医科大学骨外科学系

摘要(Abstract)：

[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。

关键词(KeyWords)： 椎管成形;腰椎;儿童;选择性脊神经后根切断术;脑瘫

Abstract:

Keywords:

基金项目(Foundation): 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)

作者(Author): 白金柱;洪毅;王一昕;张军卫;唐和虎;姜树东;李想;王方永;

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DOI:

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