后路漂浮法减压内固定治疗严重黄韧带骨化型胸椎管狭窄症

Treatment of Thoracic Spine Stenosis by Laminectomy Using “Lamina Floating” Technique and Internal Fixation with Severe Ossification of the Ligamentum Flavum by Pedicle Screw

目的探讨经后路漂浮法减压及内固定术治疗严重黄韧带骨化型胸椎管狭窄症的疗效。方法 2007年1月至2010年10月,我科收治严重黄韧带骨化型胸椎管狭窄症15例,根据Miyakoshit分型均为融合型,其中男7例,女8例;年龄40～67岁,平均56岁。所有患者术前均行X线、CT、MRI检查,并采用后路漂浮法减压+椎弓根钉内固定术。通过JOA评分、并发症发生情况评估疗效。结果术后15例均获得随访,随访5个月～3年,平均10.3个月。根据JOA评分进行疗效评价,优10例,良3例,可2例,优良率86.7%。其中2例出现硬脊膜撕裂,经腰背筋膜修复后痊愈。结论后路漂浮法可以安全有效地对受压胸髓实现减压,椎弓根钉内固定可以提供脊柱稳定,是治疗黄韧带骨化型胸椎管狭窄症的良好术式。

Objective To evaluate the effect of laminectomy using ＂lamina floating＂ technique and internal fixation by pedicle screw to thoracic spine stenosis with severe ossification of the ligamentum flavum（OLF-TSS）.Methods From January 2007 to October 2010,15 patients of OLF-TSS in the hospital treated with laminectomy using ＂lamina floating＂ technique and internal fixation by pedicle screw were retrospectively analyzed according to Japanese Orthopaedic Association（JOA）scoring system and complications.Results The mean follow-up period was 10.3 months（ranging from 5 months to 3 years）.According to the JOA scoring system,excellent in 10 cases,good in 3 cases,the excellent and good rate was 86.7%.2 cases with cerebrospinal fluid leakage were recovered after repaired with back fascia.Conclusion Laminectomy using ＂lamina floating＂ technique is a safe and effective method for decompression of OLF-TSS,and internal fixation by pedicle screw can effectively rebuild spinal stability post-operation.So laminectomy using ＂lamina floating＂ technique and internal fixation by pedicle screw is a good choice for severe ossification of the ligamentum flavum thoracic spine stenosis.