目的：评价腰椎板切开成形术联合透明质酸钠凝胶预防硬膜外瘢痕粘连的临床疗效。方法：81例行腰椎板切开关闭成形术患者，单纯组仅行腰椎板切开椎管成形术，联合组手术的同时给予透明质酸钠凝胶。观察手术前后腰痛和下肢疼痛VAS评分、病变腰椎椎间隙高度变化，按日本矫形外科协会（JOA ）下腰痛评分标准评定临床疗效，采用腰椎M RI测量比较椎管矢状径、硬膜囊形态改变。结果：腰痛VAS评分两组间差异无统计学意义（P＞0．05），但下肢痛VAS评分两组间有统计学意义（P＜0．05）；两组术后L4～5椎间隙高度比较差异无统计学意义（P＞0．05）；两组术后临床疗效总体上基本相同无统计学意义（P＞0．05）；两组椎管矢状径比较无显著性差异（P＞0．05），联合组硬膜囊面积优于单纯组，具有显著性差异（P＜0．05）。结论：腰椎板切开成形术联合应用透明质酸钠凝胶比单独手术预防腰椎管内粘连效果更好，能够进一步减轻椎管内粘连，具有较好的临床疗效。%Objective :To evaluate the clinical effects of laminotomy displacement laminoplasty and medi-cal sodium hyaluronate gel on prevention of epidural scar adhesion .Methods :81 cases treated by laminotomy dis-placement laminoplasty were followed-up 3 years ago .The simple group was treated only by laminotomy displace-ment laminoplasty ,the combined group was treated by the same method combined with medical sodium hyaluronate gel .The outcomes were assessed on back pain VAS and lower limb VAS scoring system ,and lumbar intervertebral height changes .Acording to JOA (Japanese Orthopaedics Association) score of spine to evaluate the clinical effect , the radius vector of sagittal spinal canal and the thecal sac cross sectional area were measured by MRI .All data were analysed with statistics .Results:There was no significant difference between back pain VAS score in two groups (P>0 .05) ,but there was significant difference between lower limb VAS score (P<0 .05) .There was no significant difference between L4 ~ 5 intervertebral height in two groups (P>0 .05) .The postoperative clinical recovery effects and the radius vector of sagittal spinal canal ,there was no significant difference(P>0 .05) ,but there was significant difference between the thecal sac cross sectional area (P<0 .05) .Conclusion :Laminotomy displacement laminoplasty combined with medical sodium hyaluronate gel have a betters effects than simple operation ,it can provide better pre-vention for epidural adhesions and clinical effects .
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