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  • 中英文字幕:腰椎椎板切除融合内固定术(Lumbar Laminectomy, Fusion,Instrumented)
  • 2019年01月09日

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    Lumbar Laminectomy, Fusion,Instrumented

    腰椎椎板切除融合内固定术

     

     

    Introduction (介绍)

    A posterior lumbar laminectomy is done to correct spinal stenosis, which is a narrowing of the spinal canal caused by degenerative conditions in the lower back. Pressure on the spinal nerves (radiculopathy) exiting the spine causes pain, and a laminectomy removes part of the vertebral lamina to reduce the pressure. After removing bone, bone grafts can be added to fuse the vertebrae. where there is instability, instrumentation is added to provide greater stability to the spine.

      后路腰椎椎板切除术用于治疗腰椎管狭窄。由于腰部退变性病变导致的椎管变细,即椎管狭窄。神经根在穿出脊柱时受压(神经根病)会引起疼痛,椎板切除术将一部分椎板切除以解除压迫。当骨去除后,可以另外进行植骨将椎体融合。当存在不稳时,需要增加内固定以增加脊柱的稳定性。

     

    Incision & Laminectomy (切口和椎板切除)

    An incision is made in the middle of the low back. After the spine is exposed, surgical instruments are used to remove the spinous process, lamina, and any bone spurs that may be intruding into the spinal canal. The spinal nerves now have more space with less pressure on them.

      在腰部正中作一切口。当脊柱显露后,用手术器械将棘突、椎板以及突入椎管的骨赘去除。这样脊神经就有更多的空间,解除了压迫。

     

    Preparing for Fusion (准备融合)

    To prepare for the fusion that will stabilize the vertebrae, a motorized instrument is used to remove the top (cortical) layer of the transverse processes. This is the site where the bone grafts for the new fusion will be added.

      为了准备融合以稳定椎体,用动力设备将横突的外层皮质去除。这里是附加融合植骨之处。

     

    Stabilizing the Spine (稳定脊柱)

    Before bone grafts are added, instrumentation is introduced to stabilize the spine. A drill is used to make holes in the pedicle area of the vertebrae, and screws are placed in the drilled holes. Next, rods are positioned between the screws and fastened in place. The rod and screw instrumentation provides stability to the spine and prevents the vertebrae from moving while the bone graft fusion takes place.

      在进行骨移植之前,先植入内植物以稳定脊柱。用钻头在椎体的椎弓根区钻孔,接着顺着这些孔拧入螺钉。然后,在螺钉之间安装棒并固定。钉棒内植物增加脊柱稳定性,防止椎体在植骨融合之前发生移动。

     

    Bone Graft (植骨)

    Bone grafting can be done with pieces of a patient’s own bone (autograft), processed bone from a bone bank (allograft), or a bone graft substitute (demineralized bone, ceramic extender, or bone morphogenetic protein). To harvest a patient’s own bone for grafting, bone from the iliac crest will typically be removed through the same incision that was made to access the spine. The harvested bone is then placed along the prepared site where the top layer of bone was removed. This bone eventually grows in place, fusing the spine and providing additional stability.

      植骨可来自患者自已的骨碎片(自体植骨),来自骨库的加工骨(同种异体骨)或骨移植材料(脱钙骨、多孔陶瓷或骨形态发生蛋白)。如果从患者身上取移植骨,往往取髂棘的骨,可以与腰椎手术同一切口内取骨。取下的骨头放置于刚才准备好的部位,此处外层骨皮质已去除。最终,骨头在此生长,将脊柱融合并提供额外的稳定性。

     

    Summary (总结)

    The incisions are closed and dressed to complete the procedure. Adding the instrumentation to the laminectomy with bone graft fusion increases the strength of the spine directly after surgery, and may decrease the need for a post-operative brace. Patients often remain in the hospital for two to four days following the procedure and should avoid heavy lifting, bending, twisting, and turning for six to twelve weeks.

      关闭切口并包扎,完成手术。如果椎板切除植骨融合的同时进行内固定,可在术后即时增加脊柱的稳定性,能够减少术后支具的使用。患者术后通常住院2~4天,6~12周内需要避免负重、弯腰、扭腰及转身等。

     

    (胡佰文   译)