胸椎黄韧带骨化症的诊断及外科治疗

The clinic diagnosis and surgical outcome of thoracic myelopathy caused by ossification of ligamenta flava

目的探讨胸椎黄韧带骨化症的诊断特点及改良手术方法的疗效。方法14例胸椎黄韧带骨化症患者,临床主要表现为肢体麻木、感觉异常(13例),下肢无力、行走困难(11例),锥体束征阳性(12例),括约肌功能障碍(10例)。经X线初步筛查,MRI联合CT或CTM证实手术切除黄韧带骨化灶41个节段。该病常见于中下胸椎,其中T894个节段,T91010个节段,T101111个节段,T11125个节段。经后路骨化灶头尾侧“开窗”,两侧“截桥”的整体“漂浮”技术,去除骨化的黄韧带。按JOA评分及Hirabayashi恢复率评价手术效果,术前JOA评分1～8分,平均4.1分。结果14例随访6～57个月,平均23个月。术后JOA评分5～11分,平均9.4分,恢复率为76.8%优良率85.6%。手术中平均失血370ml,手术时间175min,所有病例均恢复自主活动。结论临床表现结合MRI和CT或CTM检查,是诊断黄韧带骨化症的重要手段,改良外科手术技术较为安全可靠,术后疗效满意。

Objective To study the diagnosis of thoracic myelopathy caused by ossification of ligamenta flava(OLF) and the influence of the improved surgical procedure on clinic effect. Methods From October 1994 to December 1999, 14 patients with thoracic myelopathy secondary to OLF were diagnosed and treated by improved procedure. The chief clinic manifestation of the disease were insidious and progressive onset of numbness, sensory loss of lower extremities or trunk, motor weakness, gait disturbance and imbalance, hyperreflexia and sphincter dysfunction. 41 levels of OLF were found by means of plain radiography,MRI associated with CT or CTM and were resected.There were 4 levels at T 8-9, 10 levels at T 9-10, 11 levels at T 10-11 and 5 levels at T 11-12. OLF were removed by means of improved posterior “floating”procedure that open “window”at cranial and caudal end and cut“bridge”at left and right side of ossified mass. The latest results were assessed according to JOA scale score system and recovery ratio. the preoperative average JOA scale score was 4.1 point (range 1 to 8 points). Results 14 patients were followed up from 6 to57 months with an average of 23 months. The postoperative average JOA scale score was 9.4 point (range 5 to 11), the recovery ratio was 76.8% and the excellent and good results was 85.6%. The average amount of blood loss was 370 ml and the average operative time was 175 minutes. Conclusion Clinic history and neurological examination associated with MRI and CT or CTM was the important means of the diagnosis of OLF, improved surgical technique was more effective and reliable.オ