经皮微通道显微镜下治疗局灶性胸椎黄韧带骨化症

Microsurgical resection of focal ossification of thoracic ligamentum flavum through percutaneous microchannel

[目的]探讨经皮微通道显微镜下治疗局灶性胸椎黄韧带骨化症的安全性及临床疗效。[方法]回顾性分析2014年6月~2016年1月采用经皮微通道显微镜下治疗6例局灶性胸椎黄韧带骨化症患者资料。所有患者均采取气管内插管全麻,俯卧位,腹部悬空,C型臂X线机下“精准定位”。于病灶对应的位置旁开后正中线2.0~2.5cm置入自行研制的脊柱旁正中“锁孔”入路工作管道系统,椎旁扩张套管循克氏针逐级钝性分离肌层,最适宜的手术通道是内径1.42 cm,并沿扩张套管外围置入。通道经蛇形链条连接固定棒,固定于床旁,C型臂X线机再次定位确认通道位于骨化黄韧带后上方。通过手术微创套管高清显微镜下,结合显微高速磨钻及枪状显微器械手术切除责任骨化黄韧带。[结果]手术时间75~120 min;术中出血量25~55 ml;术后3 d后即可下地活动,住院时间6~10 d。随访时间10~24个月,术后均未发生脑脊液漏、硬膜外血肿、截瘫等严重并发症。末次随访时患者双下肢功能恢复至正常或接近正常,JOA胸脊髓功能评分改善率为100%。按照改良Epstein标准评价术后疗效,优良率为100%。[结论]经皮微通道显微镜下治疗局灶性胸椎黄韧带骨化症疗效满意,手术时间短、手术创伤小、出血量少、并发症发生率低。

[ Objective ] To investigate the safety and efficacy of microsurgical resection of focal Ossification of the ligamen- turn flavum （OLF） of thoracic spine through percutaneous microchannel. [ Method ] Six patients with focal OLF of thoracic spine were treated at Department of Neurosurgery, Fujian Medical University Union Hospital from June 2014 to January 2016. All patients received the endotracheal intubation anesthesia. In the C arm X - ray machine, lesions was accurate positioned. In the corresponding position,2.0 -2.5 cm away from the center line,rachis ＂keyhole＂ pipeline system developed by ourself was put into the road. With vertebral side expansion casing, muscle was expanded from fine to coarse, sized from fine to heavy, fol- lowing Kirschner＇s wire. Optimum operation channel was at 1.42 cm inner diameter,and was set along the periphery of the ex- pansion casing. The microchannel was fixed in the operating table by the snake chain connection rod. With the help of the C arm X - ray machine, the channels was once again confirmed to be superoposterior the ossification of the ligamentum flavum in the spinal canal. Through the microchannel, with the aid of high - definition microscope, combined with microscopic high - speed grinding drilling and gun - shape microscopic instruments, responsible ossification of the ligamentum flavum was removed surgically. [ Result] The operative time was 75 - 120 rain and the amount of blood loss was 25 -55 ml. All patients were away from bed 3 days post-operatively. The hospital stay was 6 - 10 days. All eases were followed up for 10 -24 months. No serious complications such as eerebrospinal fluid leakage, epidural hematoma, paraplegia occurred. The function of the double lower limb could recover to normal at the last follow-up. The mean JOA score was 10.2 （range,9 -11 ） at the final follow- up. The improvement rate was 100%. According to Epstein standard, curative effects were excellent in 5 patients, good in 1. The excellent rate and good results rate were 100%. [ Conclusion] The results indicate that microsurgical resection offocal ossification of the thoracic ligamentum flavum through percutaneous microchannel is a satisfactory technique with advanta- ges of shorter hospital stay, less injury, less bleeding and lower complication rate.