用田氏骨刀行全椎板切除减压治疗胸椎黄韧带骨化症

Tian's osteotome for laminectomy decompression in treatment of thoracic ossification of ligament flavum

[目的]介绍用田氏骨刀行全椎板切除减压治疗胸椎黄韧带骨化症的手术方法和优越性。[方法]利用田氏骨刀的不同形状和薄刃特点,自外向内分层切除胸椎的全椎板直达骨化的黄韧带。切除范围：上下各超过1节椎板,两侧至小关节突关节的中份。彻底暴露骨化的黄韧带、硬膜管和脊神经根,再用神经剥离器与尖刀片分离硬膜与赘生物之间的粘连,直至硬膜管与神经根前后的致压物彻底清除干净达到充分减压为止。[结果]2000年1月-2006年1月期间,用田氏骨刀切除椎板减压的10例患者,随访期限2-4年,平均3年,5例术后基本恢复正常,3例有显著改善,2例部分改善。所有病例无术后截瘫或神经症状加重者,无硬膜撕裂、脑脊液漏并发症发生,无术后感染,所有病例切口均一期愈合。[结论]用田氏骨刀切除椎板减压,是从外向内逐层切除椎板和摘除致压物,无挤压脊髓和硬膜撕裂之虑,避免了用椎板咬骨钳切除椎板时所产生的挤压脊髓的副损伤,使手术效果大为提高。

[Objective]To introduce Tian＇s osteotome technique and its advantages for laminectomy decompression in treatment of thoracic ossification of ligament flavum.[Method]Tian＇s osteotome includes different shapes and thin knife blade,in order to remove total lamina from outside to inside layers to the ossification of ligament flavum.Range of resection covered the upper and lower more than one lamina,and both sides to the small facet joints in the midline.The ossification of ligament flavum,dura mater and spinal nerve tube should be thoroughly exposed,and then adhesion between the dura and neoplasm would be separated until the compression is eliminated completely.[Result]From January 2000 to January 2006,10 cases received Tian＇s osteotome decompression,with an average follow-up time of 3 years（ranged,2-4 years）.Patients＇ situation recover to normal in 5 cases,improved significantly in 3 cases,improved relatively in 2 cases.No postoperative complications were found e.g.paraplegia,dural tear,brain spinal fluid leakage,infection.One-stage healing was achieved in all cases.[Conclusion]Lamina is removed from outside to inside step-by-step until the compression is releases with the technique of Tian＇s osteotome,that avoid the risk of extrusion of spinal cord resulted from conventional technique of rongeur forceps.Curative effect has been improved significantly.