环抱法切除胸椎黄韧带骨化症的临床疗效与解剖学基础

Clinical efficacy and anatomical basis of encircle method for resection of thoracic ossification of ligamentum flavum

目的明确I期后入路徒手环抱法切除胸椎黄韧带骨化症的手术指征、临床疗效与解剖学基础。方法回顾2010年1月至2018年6月符合以下指征行I期后入路徒手环抱法手术切除胸椎骨化黄韧带患者20例(男9例,女11例,平均年龄55.2岁,43至75岁):第一诊断为胸椎黄韧带骨化;排除Sato分型中的融合型及结节型;排除术前CT检查具有硬膜骨化征患者;排除各节段的单侧骨化物椎管占有率大于55%患者。收集术前与末次随访的改良JOA评分、临床解剖学特点及手术时间、出血量、并发症等临床资料,予以分析总结。结果20例患者均行环抱法经后路I期切除骨化韧带,共36个节段。平均手术时间116 min,出血量131 mL。术中有1例脑脊液漏,术中予缝合,术后无症状。病例均得以随访,随访时间48~54个月,平均50.9个月。术前mJOA评分(7.50±1.02),末次随访(10.25±0.62),差异有统计学意义(P<0.05)。术后改善率平均80.43%,优13例,良7例。未出现复发病例。结论对符合手术指征的黄韧带骨化患者行环抱法切除术具有操作简单,辅助工具少,手术时间短,效疗确切的优点。术后未见复发,预后良好,值得临床推广。

Objective To identify the surgical indications,clinical outcomes and anatomical basis of one stage posterior approach encircle method for resection of thoracic ossification of ligamentum flavum(TOLF).Methods From January 2010 to June 2018,20 TOLF cases admitted in our department were selected according to following indications:1)the first diagnosis was TOLF;2)fused type and tuberous type of Sato classification was excluded.3)dural ossification signs showed on CT scans were excluded.4)patients with the ossified mass occupation rate more than 55%was excluded.Preoperative and last follow-up modified JOA score,anatomy profiles,operative time,bleeding amount,complications were recorded and retrospectively analyzed.Results Twenty cases were collected,there were 9 males and 11 females,average age was 55.2 years old(43~75 years old).All cases were successful managed by one stage posterior approach for encircle method for resection of thoracic ossification of ligamentum flavum.There were 36 segments totally.Average operative time was 116 minutes per segment.Bleeding amount was 131ml on average.There was 1 case in cerebrospinal fluid leakage.After suture was preformed,the patient recovered without any complication.All cases were successfully followedup for 48 to 54 months,with an average of 50.9 months.Preoperative modified JOA score was(7.50±1.02),last follow-up score was(10.25±0.62),there was statistical difference between two groups(P<0.05).The postoperative recovery rate was 80.43%on average,13 cases were evaluated as excellent,7 case were evaluated as good.No symptom recurrence was observed.Conclusions After careful patient selection according to indications,encircle method for resection of thoracic ossification of TOLF could be carried out with a satisfied clinical outcome,simplified procedure,less auxiliary means,short operative time,few complication and good prognosis.