摘要
目的：观察带k动脉蒂肌筋膜脂肪片的血供解剖及其对腰椎间盘突出症二次手术疗效的影响。方法：观测6例12侧成人尸体标本腰节段血管的走行及L3动脉在腰背肌筋膜血供分布。2000年1月至2007年1月共收治腰椎间盘突出症二次手术患者49例，男26例，女23例；年龄39-70岁，平均55．6岁；两次手术间隔为8个月～15年，平均6．9年。复发腰椎间盘突出症30例，硬膜外瘢痕形成17例，硬膜外囊肿2例。9例行后路腰椎椎间融合术。所有患者以L3动脉为蒂的脂肪片覆盖于椎板开窗处，术后负压引流管拔出后，将2ml几丁糖从硬膜外导管注入椎板开窗处硬膜及神经根周围。随访期间进行视觉模拟评分（VAS）与Oswestry功能障碍指数评分，并与术前进行比较。结果：解剖发现L3节段血管走行较为恒定，其穿出胸腰筋膜后形成丰富的真皮下毛细血管网。49侧患者随访5～8年，平均为5．6年。腰痛VAS评分由术前7．6±1．2降至末次随访3．6±0．5（t=5．56，P〈0．01），腿痛VAS评分由术前8．9±0．9降至末次随访3．0±0．4（t=8．61，P〈0．01）；ODI评分从术前44．1±6．2降至末次随访13．9±3．6（t=20．32，P〈0．01）。根据ODI评分评定结果：优29例，良11例，可7例，差2例。结论：带蒂脂肪片加几丁糖能有效减少腰椎术后硬膜及神经根周围的纤维化与粘连，提高腰椎间盘突出症二次手术的临床疗效。
Objective ： To investigate the blood supply of the pedicle fat grafts with the third lumbar segmental artery and its clinical effects on reoperation for lumbar disc herniation. Methods ：Twelve sides of 6 adult cadaver examples were con- tributed to investigate the courser of lumbar segmental vessels and the distribution of hypodermic capillary net of the dorsal branch of the third lumbar segmental artery. From January 2000 to January 2007,49 patients needed reoperation to treat lum- bar disc herniation ,including 26 males and 23 females with an average age of 55.6 years （ranged from 39 to 70 years）. Dura- tion between two operations ranged from 8 months to 15 years with an average of 6.9 years. Reoperative reasons included re- current lumbar disc protrusion （30 cases）postoperative epidural scar formation （17 cases）, postoperative epidural cyst forma- tion （2 cases）. Of them, 9 patients underwent posterior lumbar interbody fusion at the second operation. The pedicle fat grafts with the third lumbar segmental artery were covered on the sites of the laminectomy in these patients. After negative pressure drainage tube were pulled out,2 ml Chitsan were injected to the sites of the laminectomy and around epidural nerve root through epidural catheter. VAS score and the Oswestry Disability Index （ODI） were used to assess clinical outcomes before and after operation. Results ：The courser of third lumbar segmental vessels were invariant at the lateral face of the lumbar ver- tebral body. The dorsal branch of the third lumbar segmental artery penetrated thoracolumbar fascia and formed rich hypoder- mic capillary net in the region. All patients were followed up from 5 to 8 years with an average of 5.6 years. VAS score of low back pain and leg pain decreased respectively from preoperative 7.6±1.2,8.9±0.9 to 3.6±0.5,3.0±0.4 at final follow-up （P〈 0.01 ） ;and ODI score decreased from preoperative 44.1±6.2 to 13.9±3.6 at final follow-up （P〈0.01）. According to ODI score to evaluate the clinical outcomes, 29 cases got excellent results, 11 good, 7 fair, 2 poor. Conclusion ：The pedicle fat grafts with the third lumbar segmental artery and Chitsan can reduce epidural scar formation and prevent peridural fibrosis and adhesion and improve clinical effects of reoperation for lumbar disc herniation.
出处
《中国骨伤》
CAS
2014年第5期401-404,共4页
China Journal of Orthopaedics and Traumatology
关键词
解剖
带蒂脂肪片
瘢痕
粘连
Dissection
The pedicle fat grafts
Cicatrix
Adhesions
