两种方法治疗黄韧带骨化所致的胸椎管狭窄症的对比

A comparative study of two operative methods for thoracic spinal stenosis caused by ossification of the ligamentum flavum

目的 比较黄韧带骨化所致的胸椎管狭窄症的两种手术的疗效.方法 我科收治的29例胸椎管狭窄症患者根据手术方法不同,分为两组.A组,切除骨化黄韧带及与之粘连的硬脊膜;B组,先将骨化的黄韧带用磨钻磨薄,后保留完整的硬脊膜,使黄韧带“漂浮”.术后分别随访3、6、12个月.并记录所有患者术前及术后的日本骨科协会（JOA）评分.结果 随访结果显示,A组患者3个月后复查JOA评分从术前的（5.21±1.27）分增长至术后的（6.80±0.88）分;6个月后患者复查JOA评分增长至术后的（6.91 ±0.80）分;12个月后患者复查JOA评分增长至术后的（6.82±0.91）分,3次随访结果差异均有统计学意义（P＜0.05）;B组患者3个月后复查JOA评分从术前的（5.31 ±1.38）分增长至术后的（7.25±1.34）分;6个月后患者复查JOA评分增长至术后的（7.29±1.30）分;12个月后患者复查JOA评分增长至术后的（7.22±1.37）分,3次随访结果差异均有统计学意义（P＜0.05）.通过术中观察硬脊膜颜色、搏动等及术后影像学检查,确定全部患者达到术中彻底减压.结论 两种手术方法治疗黄韧带骨化与硬脊膜粘连患者均有效.但硬膜切除减压法较薄化漂浮法易出现脑脊液漏等并发症.

Objective To compare the effects of two kinds of operations for thoracic spinal stenosis （TSS） with ossification of the ligamentum flavum （OLF）.Methods Twenty-nine participants diagnosed with TSS underwent surgery in our hospital.According to the methods of operation,they were divided into two groups.In group A,the OLF and dural adhesion were removed.In group B,the OLF was thinned by the burr drill,the dura was preserved,and the OLF was floated.All the patients were followed up for 3,6 and 12 months.The preoperative and postoperative the Japanese orthopaedic association （JOA） scores were recorded before and after operation.Results The average JOA score in group A was increased from 5.21 ± 1.27 to 6.80 ±0.88 after 3 months and to 6.91 ±0.80 after 6 months and to 6.82 ±0.91 after 12 months,and that in group B was increased from 5.31 ± 1.38 to 7.25 ± 1.34 after 3 months and to 7.29 ± 1.30 after 6 months and to 7.22 ± 1.37 after 12 months.There were significant difference in the average JOA score in the three paired results （P 〈 0.05）.All the patients had complete decompression.Conclusion Both of the two decompression methods are effective for OLF and dural adhesion.Morever,the method of OLF with spinal dural adhesion resection can cause some complications more easily such as cerebrospinal fluid leak.