胸椎黄韧带骨化症的手术治疗

Surgical treatment for ossification of the ligamentum flavum in the thoracic spine

目的研究胸椎黄韧带骨化症(OLF)的诊断与手术治疗方法,讨论其病因、病理、手术效果与并发症。方法对手术治疗的75例OLF病例进行回顾性研究。最常见早期症状是下肢麻木、无力和间歇性跛行。手术方法均采用椎管后壁和骨化韧带切除减压,按“孤立-磨薄-整块-切除”的揭盖法将病变节段椎管后壁切除,解除对脊髓和硬膜的压迫。结果75例中,无一例加重,术后55例随访1. 5年以上, 9例经短期观察。优34例、良19例、可6例、差5例。结论 胸椎黄韧带骨化所致的脊髓病表现复杂。手术治疗须谨慎操作。手术近期效果良好,但并发症较多。“孤立-磨薄-整块-切除”揭盖法有助于防止脊髓损伤、提高手术安全性。

ObjectiveTo study the characteristics of diagnosis and surgical treatment for ossification of the ligamentum flavum(OLF) in the thoracic spine, and investigate its etiology ,pathology, operative effect and complications. Methods Seventy-five cases of OLF treated surgically were studied retrospectively. The early clinical features of the disease were progressive onset of numbness, weakness and intermittent claudication of the lower extremities. Removing the posterior wall of the thoracic spinal canal was operated with the technique of 'isolating-thinning-separating-removing'. Results Fifty-five cases were followed up for over 1.5 years, and 9 cases were observed for a short time. The results were excellent in 34 cases, fine in 19, fair in 6 and poor in 5. ConclusionThe clinical features of thoracic myelopathy caused by OLF are very complex. Surgical treatment must be carefully operated and has recent favorable effects on the patients with OLF but with more complications. The technique of 'isolating-thinning-separating-removing' is a safe , convenient and effective method for the surgical treatment of OLF.