经根黄通道减压手术治疗连续型胸椎黄韧带骨化症

Decompression through pedicel-flavum tunnel for continuous thoracic ossification of ligamentum flavum

目的：探讨经根黄通道减压手术治疗连续型胸椎黄韧带骨化症的可行性和疗效。方法：2006年6月～2012年9月采用经根黄通道八边形游离整块切除法治疗连续型胸椎黄韧带骨化症患者56例，男35例，女21例；年龄31～73岁，平均51.9岁。连续两节段骨化减压41例，连续三节段骨化减压10例，连续四节段骨化减压4例，连续五节段骨化减压1例。共减压133个骨化节段，其中CT分型45个为单侧型骨化，34个为双侧型骨化，54个为连接型骨化。CT仿真内窥镜观察所有减压的骨化节段中共有上、下根黄通道各221个，其中单侧型骨化节段有上、下根黄通道各1个，双侧型和连接型有上、下根黄通道各2个。术前和术后2d、1个月、3个月及末次随访时采用日本骨科协会（JOA）评分评估神经功能情况。结果：均顺利完成手术，手术时间3.7±0.8h，术中出血量260±120ml。51例术后症状立即缓解；5例发生脑脊液漏，经对症处理后痊愈。所有病例术后伤口均一期愈合，无窦道形成、蛛网膜下腔感染、神经症状加重等并发症发生。随访13～38个月，平均23.2个月。术后2d、1个月、3个月和末次随访的JOA评分分别为6.37±2.89、8.73±1.58、9.45±1.03、9.67±1.07分，与术前评分5.14±1.59分比较，神经功能明显改善（P＜0.05）。末次随访时，JOA评分改善率为50%～100%，平均（75.24±18.01）%；疗效为优38例，良13例，可5例，优良率为91.07%。结论：经根黄通道减压手术是治疗连续型胸椎黄韧带骨化症可行、有效、相对安全和简便的方法。

Objectives： To investigate the effect of decompression through pedicle-flavum tunnel （PFT） for continuous thoracic ossification of ligamentum flavum （TOLF）. Methods： From June 2006 to September 2012, 56 patients（35 males, 21 females; 31-73 years old, average 51.9） with continuous TOLF were enrolled in our study. Among the 56 patients, decompression surgery through PFT was performed in 2 continuous levels in 41 cases, 3 continuous levels in 10 cases, 4 continuous levels in 4 cases, 5 continuous levels in 1 case, a total of 133 ossified segments was decompressed. According to the axial CT classifications, among 133 ossified segments, 45 were lateral type, 34 were bilateral type, 54 were connect type. There were 1 upper PFT and 1 lower PFT in lateral type, 2 upper PFTs and 2 lower PFTs in bilateral and connect type, a total of 221 upper PFTs and 221 lower PFTs. All patients underwent upper facet joint en bloc resection through PFT. The neurological status was evaluated by JOA scores preoperatively and at 2 days, 1 month, and 3 months after surgery and the final follow-up. Results： All patients were successfully operated with surgery time of 3.7±0.8h, blood loss of 260±120ml. 51 patients′ initial symptoms were significantly alleviated postoperatively;5 patients experienced transient cerebrospinal fluid（CSF） leakage postoperatively, and the CSF leakage disappeared after conservative treatment. All the incisions healed. No neurologic deficit, meningitis, wound infection or spinocutaneous fistula was noted during the follow-up. The JOA score at 2 days, 1 month, 3 months after surgery and final follow-up was 6.37±2.89, 8.73±1.58, 9.45±1.03, 9.67±1.07 respectively, which showed significant difference compared with the preoperative JOA score of 5.14±1.59 （P〈0.05）. At the final follow-up,the recovery rate calculated by JOA scores was （75.24±18.01）%, ranged from 50%-100%. And the surgical out come was excellent in 38 cases, good in 13 cases, fair in 5 cases. Conclusions： Decompression surgery through PFT is reliable and effective for continuous TOLF.