Lumbar Distraction and Decompression in Reducing Neuroforaminal Stenosis

減壓及擴張手術對腰椎間孔狹窄的效果

郜漢中(Han-Chung Kao)；費麗莎(Lisa Fay)；袁菲力(Philip Yuan)；羅亞瑟(Arthur E. Rosenbaum)；劉建麟(Chen-Lin Liu)；袁漢生(Hansen A. Yuan)；湯姆愛德華(Tom W. Edwards)

distraction ； decompression ； spinal tenosis ； neuroforamen

Journal of Orthopaedic Surgery Taiwan

10卷1期（1993 / 03 / 01）

57 - 70

英文

六個新鮮人體腰椎標本，事先已由X光確定在第四。五節之間的腰椎間神經孔嚴重狹窄，我們以定量的方式來測量其高，寬及面積，首先使用工程量尺，一整盒精密鑽頭及電腦斷層掃描三種不同的方式來量取這些數值，然後再模擬六種不同的手術方式後做同樣的測量。(擴張，後彎擴張，平背擴張，減壓手術，減壓後擴張，減壓後後彎擴張)。這些資料經分析比較後，我們發現腰椎間孔的改變與椎間盤後緣的高度變化關係非常密切(R≧0.92)然後椎間盤前緣的改變正好相反，也就是說再退化的腰椎後面的手術操作祇能造成整各活動椎節(motion segment)的旋轉，而無法完全拉開已退化的椎間盤空間，我們的實驗證明最顯著的腰椎間孔大小的增加在於減壓手術後合併擴張步驟或合併後彎擴張。這兩種方式均可增加腰椎間神經孔道大約60%而其它的手術方式最多祇能增加37%。

Six fresh frozen mature cadaver lumbar spines exhibiting for-aminal stenosis at the 4th and 5th level were obtained. Three types of measureing techniques (caliper, circular blunt probes with fine increment, and CT scan) were used to measure the neuroforaminal dimensions. All measurements were repeated for seven successive surgical procedures (control, distraction,lordosis, flat back, decom. pression, decompression with distraction, and lordotic distraction after decompression). Each specimen orientation, in distraction or lordosis, was clinically simulated using Steffee plates to maintain position. Following fixation, specimens were frozen in position to prevent changes during the series of measurements and the CT evaluation. It was observed that changes in foraminal height and area were closely correlated with the posterior disc heights change for each of the measurements (R2≧ 0.92).Anterior disc heights showed changes in the opposite sense. The data reflected the segmental rotation produced by the various posterior surgical procedures on degenerative spine. Comparisons were made of the changes in foraminal size following each procedure. Only moderate improvement was obtained for decompression or lordotic procedures applied alone, less than 37% increase. The results indicated that the most significant increase in the foraminal area was obtained by decompression with distraction or decompression with lordosis (p ＜0.01) with a mean increase in area of more than 60% in each case.