胸椎黄韧带骨化症的CT分型及手术方式选择

CT classification and surgical choice for thoracic ossification of ligamenta flava

目的:探讨胸椎黄韧带骨化症的CT分型及手术治疗方法。方法:1997年1月至2006年12月手术治疗胸椎黄韧带骨化症患者48例102个节段,根据CT表现分为3型,单侧型18个节段,双侧型45个节段,两侧融合型39个节段。单侧型将椎板、关节突内侧和未骨化处磨薄,再把骨化物对侧和头尾侧充分减压使其孤立,用枪状咬钳将关节突内侧磨薄处咬开使其游离,齿镊夹住骨块轻提起由中间向外侧剥离摘除骨块;双侧型将椎板、关节突内侧和未骨化处磨薄,先将骨化物头尾侧充分减压,将中间未骨化黄韧带咬除分隔,使两侧骨化物孤立,再按单侧型手术方法逐块处理;两侧融合型将椎板、关节突内侧和未骨化处磨薄,先将骨化物头尾侧充分减压,从对侧关节突内侧磨薄处咬开使骨化物孤立,再将术侧关节突内侧磨薄处咬开使骨化物游离,齿镊夹住骨块轻提起由对侧向术者侧剥离摘除骨块。术前术后采用改良JOA下肢运动功能评分评价运动功能。结果:全部患者顺利完成手术。手术时间平均2.8h,出血量平均290ml。术后无症状加重病例,1例出现脑脊液漏,经保守治疗后痊愈。40例患者随访5～62个月,平均28个月,JOA下肢运动功能评分术前1.8±1.1分,末次随访时为3.7±0.6分,与术前比较差异有显著性(P<0.01)。疗效按JOA评分改善率优32例,良6例,可2例,优良率为95%。结论:对胸椎黄韧带骨化症患者根据CT分型采取不同的手术方式可取得满意的治疗效果。

Objective：To explore the correlation between CT classification and surgical choice for thoracic ossification of ligamenta flava （OLF）.Method ： From Jan. 1997 to Dec. 2006,48 patients （totally 102 segments） with thoracic OLF who were undergone operation,were divided into 3 types according to the morphologic features of the CT scan,which include 18 unilateral segments,45 bilateral,39 fused.Different surgical procedure was applied to one of the 3 types of OLF.For the unilateral OLF,firstly,the lamina,the lateral wall of articular process and the peri-ossified spot were burred to a thin layer,then both the head and the caudal of the OLF were thoroughly decompressed,the ossified mass was isolated,finally,the thin layer of bone block was removed.For bilateral OLF,the main procedures were the same as what were used in the unilateral OLF,then the non-ossified tigamenta flava was removed,so as to the ossified mass was isolated and separated into 2 parts, the 2 parts of the OLF were removed separately at last.For the fused OLF,the key point of the procedure was the ossified mass should be burred to a thin layer along the edges of the articular process,then the mass was isolated and removes as a piece.The preoperative and the postoperative motor function of lower limb were evaluated with modified JOA scoring system.Result：All the cases were operated successfully.The average operation time was 2.8h.The average blood loss was 29Oral.No deterioration of neurological function was found. 1 case had CSF leak,which healed by conservative treatment.40 cases were followed up for 5-62 months （mean 28 months ）.Preoperative motor function of lower limb was 1.8±1.1 ,what was improved to 3.7±0.6 post- operatively.The difference had statistical significance （P〈0.01）.The outcomes were evaluated according to JOA scoring system,excellent in 32 cases,good in 6 cases,fair in 2 cases,and excellent and good rate was 95%. Conclusion：Different surgical procedures will be safely and effectively applyed to treat thoracic ossification of ligamenta tiara according to CT classification of OLF.