有限层间减压与全椎板切除术对退变性腰椎管狭窄症患者鞘内容积的影响
The effect of limited interlaminar decompression versus complete laminectomy on intrathecal volume in degenerative lumbar spinal stenosis.
作者信息
Krämer R, Wild A, Haak H, Borowski St, Krauspe R
机构信息
Department of Orthopedics, Heinrich-Heine University Hospital, Duesseldorf.
出版信息
Biomed Tech (Berl). 2002 Jun;47(6):159-63. doi: 10.1515/bmte.2002.47.6.159.
INTRODUCTION
There is a controversial discussion about the adequate surgical procedure for degenerative lumbar spinal stenosis. Due to the observation that the degenerative lumbar spinal stenosis takes place predominantly at the interlaminar region on the level of the disc involving facets and bulging of the ligamentum flavum, resection of the whole lamina might not be necessary. A biomechanical study was designed to assess the effect of different decompression techniques using cadaver lumbar spine models.
METHODS
Twelve cadaver spines with CT verified degenerative lumbar spinal stenosis were dissected in order to measure the volume of the dural sac at different flexion and extension angles. Each segment (L3/4, L4/5) was decompressed first by limited interlaminar decompression and second by complete laminectomy. Intrathecal volume measurements were taken initially, after limited interlaminar decompression and after complete laminectomy.
RESULTS
Before surgical procedure, the cadaver spines showed an increase of the intrathecal volume in flexion and decrease in extension. After limited interlaminar decompression, there was a significant reduction of volume loss in extension. There was no significant additional reduction of volume loss in extension after complete laminectomy in comparison to limited interlaminar decompression.
CONCLUSION
The results allow to conclude that limited interlaminar decompression is efficient for decompression in degenerative lumbar spinal stenosis.
引言
关于退行性腰椎管狭窄症的适当手术方法存在争议。鉴于观察到退行性腰椎管狭窄主要发生在椎间盘水平的椎间区域，涉及小关节和黄韧带膨出，可能无需切除整个椎板。设计了一项生物力学研究，以使用尸体腰椎模型评估不同减压技术的效果。
方法
解剖12例经CT证实患有退行性腰椎管狭窄症的尸体脊柱，以测量不同屈伸角度下硬脊膜囊的容积。每个节段（L3/4、L4/5）先进行有限的椎间减压，然后进行全椎板切除术。在手术前、有限的椎间减压后和全椎板切除术后进行鞘内容积测量。
结果
手术前，尸体脊柱在屈曲时鞘内容积增加，伸展时减小。有限的椎间减压后，伸展时容积损失显著减少。与有限的椎间减压相比，全椎板切除术后伸展时容积损失没有显著进一步减少。
结论
结果表明，有限的椎间减压对退行性腰椎管狭窄症的减压是有效的。
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