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[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 investigate the value of posterior rhizotomy with spinous process lamina ligament compound replantation in the treatment of selective posterior rhizotomy (SPR) in children and its outcome after operation. [Methods] A retrospective analysis of 36 cases of 68 patients with cerebral palsy undergoing SPR for lumbar spine from July 2007 to December 2009 in our hospital. The average age of surgery 6.5 years old. Spinal canal forming method for spinous process vertebral supraspinous ligament complex after the whole piece split longitudinally split, in situ coverage replantation, silk fixation and reconstruction of the supraspinous ligament continuity. Postoperative follow-up of patients with symptoms and imaging assessment of lumbar stability, replantation of laminar fusion and prognosis. [Results] The average follow-up was 32 months. No postoperative patients with low back pain. The muscle tension of both lower limbs decreased from 2.2 ± 0.6 preoperatively to 0.5 ± 0.2 postoperatively, with significant difference (P <0.05). There were no obvious abnormalities in 19 cases of lumbar X-ray; 16 cases showed lumbar postoperative changes; 12 cases of lumbar flexion and extension before and at the time of follow-up showed no significant change. Lumbar CT, spinal canal morphology were basically intact, the rate of translaminar fusion (85.3%), the absorption rate (61.8%) was statistically negative correlation between the two. 2 cases of lumbar MRI showed partial loss of replantation lamina, dural sac without compression, continuous supraspinous ligament. [Conclusion] The application of replantation of lumbar vertebral canal laminoplasty of spinous process lamina ligament complex in children with SPR can reconstruct the stability of lumbar spine well. The follow-up of more than 2 years has the phenomenon of replanted laminectomy, but it has no obvious effect on lumbar spine development. The plate and the surrounding soft tissue together protect the nerves in the spinal canal.