超声骨刀辅助椎管后壁整块切除治疗胸椎黄韧带骨化症的临床疗效观察

Clinical effect of ultrasonic bone curette assisted en bloc resection of the posterior wall of the spinal canal in the treatment of thoracic ligamentum flavum ossification

目的探讨超声骨刀在胸椎黄韧带骨化症(thoracic ligamentum flavum ossification,TLFO)减压手术中应用的有效性与安全性。方法回顾性分析2017年9月至2020年12月,确诊为TLFO并应用超声骨刀辅助椎管后壁切除减压术的患者16例,其中男11例,女5例;年龄38~79岁,平均(56.3±9.1)岁,共计切除35个节段。记录椎板切除时间、出血量、神经根和脊髓损伤、硬膜损伤和脑脊液漏发生率,随访评估患者症状改善情况。结果16例每个节段胸椎管后壁切除的时间为2.1~7.1 min,平均(4.67±1.52)min,平均术中出血量为(258.13±179.41)ml。均无伤口感染、神经根及脊髓损伤、硬膜外血肿发生,1例脑脊液漏、保守治疗后好转。所有患者均获得随访,平均随访时间为(15.4±5.9)个月。疼痛视觉模拟评分(visual analogue scale,VAS)由术前7.69±1.20降至末次随访的2.81±1.17,Oswestry功能障碍指数(oswestry disability index,ODI)由术前77.94±7.77降至末次随访的18.68±4.18,术前和末次随访的日本骨科协会(Japanese Orthopaedic Association,JOA)评分分别为5.56±1.03及9.25±1.13,差异均有统计学意义(P<0.001)。根据MacNab功能评定,优11例,良3例,可2例。结论应用超声骨刀辅助椎管后壁整块切除治疗TLFO手术时间短、并发症发生率低,临床效果满意。

Objective To investigate the effect and safety of ultrasonic bone curette in the decompression of thoracic ligamentum flavum ossification(TLFO).Methods From September 2017 to December 2020,16 TLFO patients were treated with ultrasonic bone curette assisted en bloc resection and decompression,including 11 males and 5 females;the age ranged from 38 to 79 years,with an average of(56.3±9.1)years;35 TLFO segments were removed.The time of laminectomy,blood loss,nerve root and spinal cord injury,dural tear,and incidence of cerebrospinal fluid leakage were recorded;postoperative pain and function of the patients were evaluated.Results The time for resection of the posterior wall of each segment of the thoracic spinal canal was(2.1 to 7.1)min,with an average of(4.67±1.52)min;the average intraoperative blood loss was(258.13±179.41)ml.There was no wound infection,nerve root damage,spinal cord injury,or epidural hematoma.One case of cerebrospinal fluid leakage was recorded,who improved after conservative treatment.No patient was lost to follow-up,and the mean followed up was(15.4±5.9)months.The visual analogue scale(VAS)decreased from preoperative(7.79±1.20)to(2.81±1.17)at the last follow-up;the Oswestry disability index(ODI)decreased from(77.94±7.77)preoperatively to(18.68±4.18)at the last follow-up;the Japanese Orthopaedic Association(JOA)scores of preoperative and final follow-up were(5.56±1.03)and(9.25±1.13),respectively;all these differences were statistically significant(P<0.001).According to the MacNab function assessment,11 cases were excellent,3 cases were good,and 2 cases were fair.Conclusions Ultrasonic bone curette assisted posterior wall resection has the advantages of shorter operation time and lower complication rate in the treatment of TLFO,which achieves satisfactory clinical effect.