迂回减压折断法治疗黄韧带骨化型胸椎管狭窄症

The Method of the Undergone "Repeated" Decompression to Ossification of Thoracic Ligamentum Flavum

目的探讨迂回减压折断法治疗黄韧带骨化型胸椎管狭窄症的安全性与实用性。方法回顾性研究自2014年1月~2016年10月我科收治的黄韧带骨化型胸椎管狭窄症患者15例,其中男6例、女9例,年龄45~67岁,平均53.4岁,病程5个月~7年。所有患者术前行胸椎平片、CT及MRI,并采用迂回减压折断法手术治疗。术式要点:咬除棘突,四边开槽,保留一边骨性支撑为门轴,从对侧掀起,分离粘连,折断后完成减压。统计所有患者术前、术后神经功能的日本骨科协会(JOA)评分及术后并发症情况,根据Epstein疗效评估标准评估疗效,并与传统手术方法的优缺点进行比较。结果 15例患者均得到术后随访,术中无脊髓、神经根损伤等并发症,脑脊液漏患者2例;术后患者双下肢僵硬无力症状较前明显改善13例,逐渐缓解2例;由于粘连较重,术后出现脑脊液漏患者2例,术中细丝线缝合,术后给予对症处理后痊愈。术后JOA评分(7.87±1.55)较术前JOA评分(5.40±1.99)具有统计学意义(P<0.05);Epstein疗效评估结果:优11例,良2例,改善2例,差0例,优良率为86.7%.结论迂回减压折断法是治疗黄韧带骨化型胸椎管狭窄症的有效方法,该手术方式具有操作简单、创伤小等优点,对胸部脊髓的影响较小、安全性高。

Objective To assess safety and feasibility in a consecutive series of patients with ossification of thoracic ligamentum flavum who undergone ＂ repeated＂ decompression method.Methods Between January 2014 and October 2016,the data of 15 patients were retrospectively reviewed and analyzed.The mean age was 53.4 years（range,45 to 67 years）,all patients underwent ＂repeated＂ decompression method.The data of patients included pre-operative CR,CT,MRI,pre-and post-operative Japanese Orthopaedic Association and complications.In addition,we used Epstein evaluation criteria to evaluate the postoperative effect,and compared with traditional surgical methods.Results The average follow-up period was（37 ± 12） months.Mean preoperative JOA score was 5.40 ± 1.99,which improved to a mean of 7.87 ± 1.55 at final follow-up.Overall JOA scores showed a significant postoperative improvement（P〈0.05）.Limb stiffness and weakness were significantly improved in 13 patients,and gradually relieved in 2 cases.According to Epstein,the results were excellent in 11 cases,good in 2 cases,improvement in 2 cases,poor in 0 cases,the excellent and good rate was 86.7%.There were no other complications such as spinal cord and nerves injury.Two experienced a cerebrospinal fluid leakage because of serious adhesion,and returned to normal by post-operative symptomatic treatment.Conclusion The results suggest that the posterior approach is feasible for ossification of thoracic ligamentum flavum,and have the advantages,such as simple operation,less trauma,less disturbance to the thoracic spinal cord and high safety.