颈椎后路椎板成形术与SLAC手术

田伟 王含

（北京积水潭医院脊柱外科，北京100035）

颈椎后路椎板成形术起源于20世纪70年代，其疗效可靠，并能够明显减少椎板切除术后严重并发症的发生率。目前是治疗多节段颈椎管狭窄症和后纵韧带骨化症的常用方法。本文分别对椎板成形术的起源和发展、适应证、疗效和并发症等进行介绍，并介绍积水潭医院设计的改良术式——SLAC手术及相关经验。我们认为，棘突纵割式椎管扩大将成为椎板成形术今后的发展方向，人工骨的应用将在椎板成形术中起到重要作用。

1 椎板成形术的起源和发展

在椎板成形术出现之前的很长一段时间内，椎板切除术作为多节段病变的首选手术方法，能够良好的完成脊髓减压的任务。但其并发症却屡有出现。磨钻的应用使得椎板切除术快速进步，但仍没有解决术后颈椎易损伤、椎体后骨赘形成、曲度错乱等并发症[1]。椎板切除后还会导致颈椎不稳定，很多医生为预防不稳定继发更严重的症状，进行长节段后方固定融合，导致颈椎活动严重受限，邻节病高发，并有融合失败风险。另一严重并发症是硬膜外瘢痕形成，后方肌肉组织瘢痕会导致术后持续头痛、颈痛症状，严重者可出现神经症状恶化[2]。

1973年，Oyama介绍了一种新型后方减压术式，他在切除棘突后将相应的椎板削薄，用高速磨钻或椎板咬骨钳在每一个椎板上切出一个横置的Z字。薄层椎板被切割成两段，向后外方移动扩大椎管容积，用缝线或金属丝固定在扩大的位置上[3]。这种Z字成形术虽然还遗留了椎板切除术的一些问题，但它开创了保留后方结构的先河。

1977年，Hirabayashi设计了一种更为大胆的成形手术，后于Spine杂志上介绍了这种方法[1,4]。手术将C2-C7的棘突和椎板暴露清楚后，用磨钻在椎板和小关节之间做出深及黄韧带的骨槽，一侧切断椎板，另一侧需小心保留很薄的椎板内侧皮质。术者用剥离子或刮勺翘起椎板开口、助手用Kocher钳夹棘突向外旋转，共同完成扩大椎板的动作。Hirabayashi强调不要因夹持不紧让打开的椎板复位，伤及已向后移动的脊髓。固定方法最早使用缝线在关门一侧的小关节囊和棘突之间作悬吊，之后逐渐发展出钛板、自体及异体骨和陶瓷垫片等一些内置物，固定效果良好[5]。Hirabayashi术式一经问世便引起巨大反响，并沿用至今，英文简称“open-door”。在我国称之为单开门椎管扩大椎板成形术，常简称为单开门手术，又译为平林（Hirabayashi）法。

平林法问世之后，椎板成形术加速发展。Hukuda法弥补了平林法椎管不对称扩大的缺点[6]。Hukuda在椎板两侧均作出不切断椎板的侧沟，再用磨钻或椎板咬骨钳自后正中线打开棘突，完成椎管扩大。双侧椎板用缝线悬吊于小关节囊，椎管保持敞开状态完成手术。后人改进Hukuda法，用骨块、陶瓷等封闭其间隙，重建完整的椎弓形态。比较著名的是Kurokawa改良方法，他将棘突后半部分切除后进行自体骨移植封闭棘突间隙[7]。Tomita改良方法则将线锯应用于打开棘突，也称T-saw法[8]。Hase首先使用陶瓷封闭棘突间隙，重建椎板弓的结构[9]。此类方法根据创始人姓氏分别被译为小林（Hukuda）法、黑川（Kurokawa）法、富田（Tomita）法，英文称“French door”，取意此开门方法与法式大门相似，也称“bilateral open-door”或“double-door”。在我国称之为双开门椎管扩大椎板成形术，常简称为双开门手术。

由于椎板成形术可与椎板切除术获得相同的减压效果[10]，并保留了颈椎后方的重要结构，并发症明显减少，后被广泛应用于临床，成为使用最多的颈椎后路术式。椎板成形术的发展常伴随两类术式孰优孰劣的讨论，单开门和双开门手术均能获得良好减压效果，有研究认为双开门虽手术时间稍长，但术中出血量和围手术期并发症较少，特别是轴性症状发生率低[11]。

椎板成形术的改良方法不胜枚举。对于脊髓型合并神经根型患者，有学者将椎板成形术与Frykholm在1951年设计的Key-hole术相结合，获得了良好的神经减压效果[12-14]。有学者认为脊髓压迫仅发生在关节水平，骨水平的脊髓不受压，故设计了分段的部分椎板切除术（SPL），取得不错的效果[15,16]。其他辅助方法如术中超声评估、围术期氨甲环酸等增加了手术的安全性[17-19]。随着微创外科概念的兴起，有人采用肌间入路行椎板成形术获得良好效果，未发现曲度丢失或ROM下降等情况[16]。

2 椎板成形术的适应证

椎板成形术有两大主要适应证。

退行性颈椎管狭窄症-脊髓型（CCS-M）最为常见，此疾病之前被笼统地称为脊髓型颈椎病（CSM）。Clarke等在50年代观察了120例脊髓型颈椎病患者的自然病程，发现75%的患者症状反复出现，66%有新发或恶化的神经症状，但也有2例患者症状自发缓解[20]。其他研究认为轻度脊髓型颈椎病可以通过保守治疗获益，手术虽然可以快速缓解症状，但长期随访与保守治疗效果无差异[21,22]。当患者出现症状持续不缓解甚至加重、大小便功能障碍、进行性肌力下降、明显走路不稳、双手协调性丧失等症状，需要尽快手术干预。其他表现如疼痛、轻度肌力下降和感觉异常如果对患者带来了不能忍受的影响，也可以考虑手术治疗[23]。

颈椎后纵韧带骨化症（OPLL）是椎板成形术的第二大适应证。没有脊髓症状的OPLL患者中83.3%症状进展缓慢，无需手术治疗[24]。而有明确脊髓压迫者均能从手术中获益。OPLL患者行保守治疗时脊髓损伤几率是正常人的32倍，而脊髓损伤致残的几率高达100多倍[25]。

此外，发育性颈椎管狭窄症、其他类型的退行性颈椎管狭窄症、颈椎间盘突出症、颈椎黄韧带骨化症、脊髓肿瘤等也可视情况使用椎板成形术治疗[26-28]。有报道称椎板成形术可以作为治疗颈椎前路术后临近节段病变的方法，但其证据尚不充分[29]。

上述疾病大部分有前路和后路两种手术选择。

选择手术入路通常考虑下列因素：矢状位序列、受累节段数、狭窄形态、既往手术史、骨密度等。有人认为颈椎后凸患者行后路减压手术时脊髓漂移空间不大，有可能导致前方的压迫无法解除，疗效不佳[30]。椎板成形术的中期效果不如前路固定融合术，前方有明确压迫并局限在1～2个节段的患者适合前路手术[31]。3个或3个以上节段病变时，需固定融合节段过长，容易导致如内固定失败、融合率差、颈部僵硬及邻近节段退变等一系列问题[32,33]。对于多节段CCS和OPLL患者，有研究称前路手术在术后早期疗效较好，但并发症比后路手术多，随着时间推移，后路手术的疗效可与前路相当。一般认为除了OPLL占位大于60%或颈椎后凸等情况，椎板成形术是更好的选择[34-36]。K-line被提出用来指导手术入路选择，有研究称越过K-line的OPLL做椎板成形术效果较差[37]。也有人认为OPLL行前路或后路的区别不大[38,39]。

总结起来，颈椎椎板成形术的适应证为三节段及以上的有明显脊髓压迫表现上述疾病[40]。

椎板成形术的绝对禁忌证很少，通常认为颈椎后凸是其禁忌证，但在实际运用中往往需要个体化判断。有试验表明术前C2-C7前凸小于3°的患者术中监测脊髓漂浮不满意，并降低临床疗效[41]。有人选择在椎板成形术同时行侧块或椎弓根固定融合术以恢复颈椎前凸，达到良好减压目的。退行性颈椎管狭窄症患者年龄较大，有研究表明65岁以上老年人术前与术后JOA评分虽较低，但其增加值并不低，故高龄不是椎板成形术的禁忌证[42,43]。但年轻患者应慎重选择后路手术。术前要明确诊断，当颈椎病合并其他疾病如脊髓结节病时，手术效果较差[44]。

3 椎板成形术的疗效、并发症及预后

3.1 疗效

3.1.1 神经症状：大多数研究表明椎板成形术在缓解术前神经症状方面效果很好。行走功能往往是脊髓压迫患者最期望恢复的，有学者称80%的术前行走不稳患者可好转。也有观察研究显示术后下肢运动功能和上肢感觉功能的改善率较低，容易成为遗留症状[45,46]。为统一疗效指标，多数学者使用JOA评分评价，其中JOA改善率的计算方法是：（术后JOA-术前JOA）/（17-术前JOA）×100%。文献中报道的中短期JOA改善率一般在50%～70%，与术前脊髓症状的严重程度相关，而与具体术式无关[8,47-64]。单开门和双开门手术都能提供足够的脊髓漂移空间[65]。随机对照试验表明单开门和双开门的JOA评分改善率无差异[11]。一般认为两种术式的神经减压效果相似。目前超过10年长期随访JOA改善率仍能保持在55%～60%[66,67]。

语篇环境主要体现的是语言的整体性，也就是画面、声音和字幕这三者有机结合的一个整体。故事，情节，画面以及人物的各个要素都是相互依存的，缺一不可。语篇限制下的策略就是时刻要保持人物对白的连贯性，使得更具推理性和逻辑性。同时，也要重点关注说话人的语气、动作、内心、情感的表达，使得译文符合影片的整体语境。

大部分研究称两大适应证之间无明显疗效差异。也有研究称虽然一部分OPLL患者长期随访症状有进展，CSM较OPLL改善稍好，但更加重要的决定因素是术前症状严重程度和持续时间[68]。另一研究认为OPLL虽有自然进展倾向，但长期随访显示仅20%的患者出现症状反复[62]。

脊髓压迫体征在术后半年内可基本缓解。其中Babinski征和肱桡反射亢进多数恢复正常，且是有效的复发观察指标。而Hoffman征的变化不够敏感[69]

3.1.2 术后颈椎曲度：目前仍没有可以完全预防椎板成形术后后凸形成的办法[70]。根据报道，术后曲度丢失比一般在22%～53%[50,51,53,58,68,71-73]。个别研究使用后方固定能保持较好的曲度[60]。近年来由于特别强调对颈后肌群的保护，以及各种改良术式的出现，让术前后凸不再是绝对手术禁忌，有研究称49.2%的后凸能在术后转变为前凸，但同时有7.2%的前凸成为后凸[74]。另有研究称前凸角小的患者术后转为后凸的可能性大，术前小于10°就需特别注意[75]。

3.1.3 术后颈椎活动度：文献报道的颈椎活动度（ROM）下降在30%～70%之间[9,66,76]，平均约50%[77]，早期手术甚至更低[62]。ROM下降造成的不良后果包括颈部僵硬及邻近节段退变等。有报道称术后ROM呈逐渐下降的趋势，但下降的速率逐渐减缓，18个月后停止下降。OPLL患者术后ROM下降更大[77]。一些学者认为术后ROM下降的原因是颈后伸肌群剥离过多。术中保护颈后伸肌群，特别是颈半棘肌，可以维持ROM及曲度，也能减少轴性症状发生[78-80]。另一可能导致ROM下降原因是自发椎板融合，原因可能与小关节和椎旁肌的挛缩有关[81-83]。术后早期活动对预防融合有效[9]。有研究表明术后佩戴颈托4周比佩戴8周的ROM保持更好[81]，也有佩戴2周的研究取得了较好的结果[74]。由于多节段前路或后路融合对ROM极大的影响，椎板成形术在此方面仍占优势。有趣的是，一些学者视术后颈部僵硬为必要，相比椎板切除术后ROM显著上升[84]，椎板成形术能减小颈部活动时可能给脊髓带来的损伤[51]。

3.2 并发症

有研究称颈椎手术总并发症率约5%[85]。椎板成形术的一般并发症如术后血肿、术后感染、围手术期死亡发生率低[86]。术后伤口感染发生率约2%，而伤口特殊处理可降低感染率[87]。椎板成形术静脉血栓风险稍高于前路固定手术，但比后路固定手术低。由于下肢深静脉血栓和肺栓塞显著提高死亡率和住院时间，术前要特别注意高危患者的评估和治疗[88]。0.8%的患者术后出现脑脊液漏，可行头高位持续蛛网膜下腔引流治疗[89]。

3.2.1 神经症状恶化：椎板成形术后神经症状恶化并不罕见，多由椎板固定失败引起。向后翻起的椎板有复位倾向，固定不稳或内置物断裂等原因均可导致“再关门”发生，压迫已经向后移动的脊髓，造成神经症状恶化。有研究表明椎板闭合的发生率是33%，且发生椎板闭合后JOA评分有下降趋势，故推荐使用间隔物以降低椎板闭合风险[90]。另外，术中过度磨削使得关门一侧的椎板全层断裂，骨折端移位也可压迫脊髓。术后CT一般能发现恶化原因，决定是否二次手术及其方式[2]。有研究称OPLL患者术后3.1%出现下肢功能恶化，并与OPLL占位面积和厚度相关，但术后半年部分神经功能可以恢复[91]。

3.2.2 轴性症状：轴性症状（axial symptoms）是Hosono最早报道的，他发现椎板成形术后频发颈项部、肩部疼痛，且后路手术明显高于前路手术[92]。轴性症状很常见，文献报道的发生率为5.2%～61.5%，甚至有高达80%的报道[93]。通常术后很快出现，并在1年内缓解。疼痛的来源包括间盘、肌肉、小关节、脊髓和神经根[94]。产生机制尚不明确，但疼痛往往伴随颈部僵硬感，与术后ROM受限同时发生[95]。考虑可能与长时间、大范围暴露、剥离等同样影响ROM的手术操作有关[96]。有研究表明C6棘突较长者术后轴性症状发生率高[97]。预防轴性症状对于椎板成形术至关重要。术后早期活动，缩短颈托佩戴时间、减少手术暴露、保护颈半棘肌C2止点、重建伸肌群等可预防轴性症状[94,98,99]。NSAIDS类药物、颈部锻炼等方法可能对已出现的症状有效。

3.2.3 C5神经根麻痹：神经根损伤是后路减压手术常见的并发症，有些学者发现在术中非常仔细地保护神经根的情况下，术后仍有麻痹情况出现，尤其是出现在C5神经根。此类报道较多，多表现为三角肌肌力下降和肩痛，感觉受累少。这一特殊现象被命名为C5神经根麻痹（C5palsy）。文献中平均发生率约为4.6%～4.8%[100,101]。有研究认为其在不同术式、不同疾病间的发生率无明显差异[100]。但也有研究表明OPLL、术后前凸增大、单开门手术等情况易出现C5麻痹[102,103]。C5麻痹的发生机制尚不清楚，有人认为这并非术中神经根或脊髓损伤直接引起[104]。也有人认为其与医源性损伤、脊髓移位牵拉、脊髓缺血和再灌注损伤有关[101]。其中由于脊髓向后移动时对神经根造成牵拉，神经根在椎间孔内移动时的机械损伤原因被较多人认可[105,106]。针对此原因，有学者建议在行椎板成形术同时同时行椎间孔切开（key-hole）术，试图让神经根不受椎间孔的限制，以预防C5麻痹，但效果不十分确切，甚至有神经根麻痹发生率不降反升的报道[100,107]。另有同类研究称此方法有效[108]。有人试图控制开门程度，让脊髓有限制地后移，控制硬膜的膨胀以预防C5神经根麻痹，获得了一定的效果[109]。C5麻痹患者的神经功能可以恢复，预后良好，肌力下降通常在1年内恢复或接近正常，症状越重需要越长时间的恢复过程[100]。

3.3 预后

研究表明，手术时年龄小于60岁、术前病程小于1年者，术后JOA改善率较高，手指10 s屈伸试验恢复较快，预后较好[110,111]，但年轻OPLL患者仍可能快速进展从而影响预后[112]。有研究称术后24 h内手指15 s屈伸试验会有明显改善，并能预测长期预后[113]。术前脊髓高信号累及节段多、脊髓压缩比低被认为是预后较差的表现[114]。另外，术前神经电位、术前K-line位置、术后是否存在脊髓前方压迫（ACS）、是否合并糖尿病等因素也能影响预后[115-118]。椎板成形术后需要二次手术的原因包括手术技术失误、术后症状不缓解、疾病自然进程导致的症状再发等。有报道称9.2%的患者需要翻修手术，其中67%是疾病自然进程所致。所以医生需在术前告知患者此可能性[119]。

4 SSLLAACC手术

积水潭医院学习国际先进经验，借鉴Hukuda、Kurokawa、Nakano[120]、Tomita[121]等方法，20世纪90年代起开展椎板成形术7年，我院和国内厂家合作，自主研发、生产了由天然珊瑚煅造制作的棘突间隔物，称为珊瑚人工骨（coralline hydroxyapatite，CHA，图1），替代自体骨做间隔物进行棘突纵割双开门椎管扩大椎板成形术。手术中应用线锯（threadwire saw，T-saw）割开棘突。我们取手术关键步骤英文（spinous process splitting laminoplasty using coralline hydroxyapatite）的首字母，定名为SLAC手术。

图1 积水潭医院合作研发的珊瑚人工骨

SLAC-Ⅰ型手术步骤简述如下：颈正中切口，暴露C2-T1棘突，剪下的颈半棘肌用丝线标记；分别从C7/T1和C2/3间隙切除部分黄韧带，从C7/T1椎间隙穿入特制的硬膜外导管，至C2/3椎间隙穿出，从导管内穿入T-saw，纵行劈开C3-C7棘突；用高速磨钻在C3-C7两侧椎板根部、小关节内侧做侧沟；正中掀开棘突，扩大椎管并去除粘连压迫组织；见到硬膜囊后移并有明显搏动后，于各劈开棘突间植入珊瑚人工骨，丝线固定于棘突；交叉缝合两侧颈半棘肌，逐层关闭切口。对于累及C2节段的高位脊髓压迫患者，使用磨钻对C2椎板行Dome减压，可获得良好减压效果[122]。

SLAC手术的关键在于魔钻、线锯和珊瑚人工骨的使用[123-125]。高速磨钻已成为颈椎后路手术不可或缺的器械，可以明显提高手术安全性，减少手术时间。T-saw在椎板成形术中的应用安全、有效[8,73]。其操作具有解剖学基础，即棘突和椎板汇聚部位下方与硬膜囊上方之间存在腔隙。当柔软、光滑的特制导管穿出后再置入线锯，不易对脊髓造成损伤。特殊情况如严重颈椎管狭窄病例，可在狭窄处两侧分段穿入两套管及线锯。T-saw可一次性将拟成形的椎板棘突割开，操作比磨钻易于控制，神经损伤可能小，对称纵割成功率高，割面平整，可与CHA间隔物良好贴附，易于固定融合。

早期研究显示，棘突纵割后应用羟基磷灰石做间隔物，可获得良好的椎管扩大效果和融合率[120]。用人工骨撑开棘突封闭椎管，可以避免椎管再关门和硬膜外瘢痕形成，可以很好地保持原有生物力学特性[126]。我们在国内首先设计并使用了珊瑚人工骨，它是以天然珊瑚为原料，经复杂热液交换反应制成。具有良好的生物相容性、骨传导性，其孔隙率和孔径大小符合颈椎后路手术要求，特有的梯形结构符合棘突敞开角度。应用CHA后，我院SLAC手术时间明显缩短，术中出血量减少，并避免了取骨部位（一般在髂骨）术后血肿、疼痛、骨折等并发症。随访2年显示其与棘突的融合率达到83.5%，并有所时间而增加的趋势。即使有少量不愈合情况，由于棘突不是主要负重部位，对疗效无明显影响。

SLAC术后棘突位置居中，有利于颈后部肌群的止点重建，达到左右平衡，最大限度地维持了颈椎的稳定性。颈半棘肌和C2、C7椎板在保持颈椎前凸方面起重要作用，是颈椎主要的稳定结构，其剥离会导致曲度丢失[127-130]，相关症状恶化危险增加[131]。我们十分重视颈部后伸肌群的保护重建，虽然早期随访发现术后有曲度恢复和轴性疼痛减少趋势，说明了后部肌群软组织功能有所恢复。但重建肌群的方法困难，有一定的失败率。

我院从2001年开始采用保留C2和C7棘突肌肉止点的方法，尽可能少的破坏颈部后方伸肌组群，保持术后前凸，防止术后轴性疼痛。改良后术式称为SLAC-Ⅱ型手术（图2）。具体方法包括：保留C2和C7棘突肌肉止点，特别注意保护颈半棘肌在C2棘突的止点；改原来的C3椎板成型术为椎板切除术；改C7椎板成形术为C7头侧部分椎板切除，注意保护椎旁肌的止点；C4-C6仍行人工骨间隔的椎板成形术。

图2 SLAC-Ⅱ型手术

我院设计的SLAC-Ⅱ型手术对颈后肌群的影响大大降低，没有剥离再重建过程。SLAC-Ⅰ型做C3椎板成形术，应用间隔物的宽度一般为15～20 mm，而C2棘突上颈半棘肌的止点平均宽度为10.6 mm[132]，使得在C2棘突上原位重建止点十分困难，有一定失败率，成功重建的位置往往也位于原止点外侧。改良后的术式将C3椎板成形改为椎板切除，不需破坏C2原本的肌肉止点，可以获得同样的神经减压效果，手术操作更加简单，并能减少轴性症状发生率[133]。C7椎板在颈椎稳定性方面有重要作用，保留C7棘突能减少轴性症状发生[134,135]。C3-C6椎板成形术在手术时间、切口长度、轴性症状发生率等方面优于C3-7椎板成形术[136]。由于切除了C3椎板，C7椎板头侧也做了部分减压，SLAC-Ⅱ型手术的减压范围十分充分，较C3-C6椎板成形术还大，能避免术后C7节段继续狭窄。改良后只需植入3块珊瑚人工骨，减少了线锯需要劈开的范围和磨钻需要做门轴的数量，手术时间较前明显缩短。松开拉钩后，由于良好的保留了颈半棘肌等颈后部肌群，肌肉层有自然合拢的趋势，使伤口缝合、愈合更加容易。术前存在明显后凸一般是椎板成形术的禁忌证，但也可在SLAC手术时同时后路侧块或椎弓根内固定，可获得良好效果并减少C5神经根牵拉[137]。

进行此项术式改良后，我院对比研究显示[64,138]，SLAC-Ⅰ型和Ⅱ型手术的JOA评分改善率分别为43.4%和46.9%，差异无统计学意义。说明Ⅱ型手术虽然减少了椎板成形范围，但减压效果是相同的，神经功能恢复方面和Ⅰ型相似。手术时间从126 min缩短到97 min。术中出血量相等。Ⅱ型C2-C7前凸角术后仅下降1.9°，ROM保留了术前的86.5%，明显好于Ⅰ型。轴性症状在Ⅰ型和Ⅱ型发生率分别为38%和15%，Ⅱ型新出现的轴性疼痛比例较低。两组合计5%出现C5神经根牵拉症状，神经根麻痹、三角肌肌力减弱的共2%，组间无差异。可见SLAC-Ⅱ型在手术时间、术后颈椎曲度、ROM和轴性症状发生率等方面均优于SLAC-Ⅰ型手术。

SLAC围手术期处理也经历了较大变化。随着手术技术的改进和观念的转变，术后卧床时间从之前的3～6 d缩短至1 d，一般术后6 h可在护士帮助下轴向翻身，术后1 d可坐起，术后2 d可下地活动，并鼓励患者早期进行功能锻炼。预防性抗生素使用从之前的5～7 d缩短为术后24 h，个别情况延长至48 h。佩戴颈托时间从最早的3～6个月以上逐渐缩短至2周，以避免术后ROM过多丢失[139-141]。

结语

椎板成形术作为颈椎后路的常用术式，已成为治疗多节段脊髓压迫疾病的首选方法。单开门手术在我国应用广泛，Hirabayashi曾将其定位为“平民手术”，意指平林法对手术技术要求较低，减压过程较简单，手术时间短、费用低。但单开门存在其固有缺陷，如椎管扩大及后方结构不对称，术后曲度、活动度下降较多，轴性症状发生较多，“再关门”发生率较高等。而我们在使用内固定物降低了关门风险的同时，也大大增加了手术时间和费用，失去了平林法的优势。相比之下，双开门手术疗效相当，并发症明显减少，患者获益增加[11,142]。我们相信，随着技术的进步和普及，棘突纵割方法将成为椎板成形术的发展方向。珊瑚人工骨已经取得了很好的效果，但我们仍期待拥有更好骨诱导性人工骨的出现。希望我国脊柱外科医师和研究者今后能在椎板成形术的发展中做出杰出的贡献。

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