胸椎黄韧带骨化的病理单元及分层八边手术法

Pathological unit and the octagonal en bloc resection of thoracic ossification ligamentum flavum

目的 描述胸椎黄韧带骨化（ossification of ligamentum flavum,OLF）的病理单元并介绍分层八边法手术,探讨OLF病理单元的意义和分层八边法手术疗效.方法 2002年1月至2007年1月,手术治疗胸椎OLF合并脊髓病患者95例,男61例,女34例;年龄31～78岁,平均53.9岁.上胸段32例,中胸段24例,下胸段39例.单节段骨化53例,双节段骨化38例,三节段骨化4例,共141个OLF节段.用CT三维同步定位像观察脊柱OLF脊柱结构.用日本骨科协会（Japanese Orthopaedic Association,JOA）括约肌功能评分和下肢运动功能评分以及运动功能恢复率评估疗效.结果 CT多平面重建观察骨化黄韧带病理单元共141个.每个病理单元规定为：与OLF所附着的关节突相邻上、下椎弓根下缘延长线之间包含的脊柱所有生理和OLF病理结构.术后随访24～60个月,平均38.3个月.术前感觉障碍及下肢麻木86例,术后完全恢复67例、部分恢复19例;术前束带感69例,均完全恢复.术前括约肌功能JOA评分为（2.262±0.561）分,术后为（2.651±0.334）分;术前运动功能JOA评分为（1.539±0.873）分,术后为（3.694±0.429）分;恢复率平均为87.57%.疗效评价：优71例、良19例、可5例,优良率为94.74%.结论 OLF病理单元更完全、准确地概括OLF的病理结构,分层八边法手术减压充分、安全.

Objective To describe the pathological unit and octagonal en bloc resection for the treatment of ossification ligamentum flavum（OLF）in thoracic spine with spondylotic myelopathy.Methods Ninety-five patients from January 2002 to January 2007 were diagnosed as thoracic OLF,61 males and 34 females with an average age of 53.9 years（range,31-78 years）.There were upper thoracic spine OLF in 32 cases,middle thoracic spine OLF in 24 cases and lower thoracic spine OLF in 39 cases.Single-segment OLF was found in 53 cases,double segments OLF was found in 38 cases and three segments OLF was found in 4 cases.CT scan multiplanar co-localized reconstruction was employed to detect the structure of spine with OLF.The Japanese Orthopaedic Association（JOA）lower limb motor function score,sphincter function score and motor function improvement rate were used to evaluate the outcomes.Results CT scan was engaged to observe 141 OLF pathological unite.The OLF pathology unit was defined as all the spine structures between the extension lines of the lower margin of the OLF two adjacent pedicles.Each OLF associates with an OLF pathology unit.The mean follow up duration was 38.3 months（range,24-60 months）.Among 86 patients with sensations disturbance before operation,67 totally recovered and 19 relieved after operation.Trunk restrictions in 69 cases before operation were completely recovered after operation.Postoperative JOA sphincter function score was 2.651±0.334,comparing with preoperation score（2.262±0.561）,and the difference was statistically significant.Postoperative JOA motor function score was 3.694±0.429,which was significantly increased than preoperative score 1.539±0.873,and motor function recovery rate was 87.57%.There was excellent in 71 cases,good in 17 cases and fair in 5 cases.The excellent and good rate was 94.74%.Conclusion The octagonal en block resection is relative safe for treatment thoracic OLF with myelopathy.Pathological unit of OLF in thoracic spine is more accurate to summarize the pathological contents and features of the OLF and its adjacent structure.