单侧双通道脊柱内镜技术治疗单节段胸椎黄韧带骨化症

Application of unilateral biportal endoscopy technique in single-segment thoracic ossification of ligamentum flavum

目的 探讨单侧双通道脊柱内镜(unilateral biportal endoscopy,UBE)技术治疗单节段胸椎黄韧带骨化症(thoracic ossification of ligamentum flavum,TOLF)的安全性和临床疗效。方法 2020年8月—2021年12月应用UBE技术治疗11例单节段TOLF患者。男6例,女5例;年龄49~72岁,平均58.2岁。责任节段:T6、71例,T7、81例,T8、92例,T9、102例,T10、112例,T11、123例。影像学检查示骨化部位位于左侧4例、右侧3例、双侧4例。主要临床症状为胸背痛或下肢痛,伴下肢麻木、乏力。病程2~28个月,中位病程17个月。记录手术时间、术后住院时间以及并发症发生情况。术前及术后3 d、1个月、3个月、末次随访时采用疼痛视觉模拟评分(VAS)评价胸背痛及下肢痛程度,Oswestry功能障碍指数(ODI)及日本骨科协会(JOA)评分评价功能恢复情况。手术前后采用CT测量冠状面椎管前后径,评价手术减压效果。结果 手术均顺利完成,手术时间50~105 min,平均80.0 min;均无硬膜囊撕裂、脑脊液漏、脊髓神经损伤或感染等并发症发生。术后住院时间2~5 d,平均3.1 d。术后切口均Ⅰ期愈合。患者均获随访,随访时间6~22个月,平均14.8个月。术后3 d CT测量示椎管前后径为(8.63±1.61)mm,较术前(3.67±1.37)mm增大(t=-12.181,P<0.001)。术后各时间点胸背痛及下肢痛VAS评分以及ODI均较术前降低,JOA评分升高,差异有统计学意义(P<0.05);术后上述指标进一步改善,除术后3个月与末次随访时比较差异无统计学意义(P>0.05)外,其余各时间点两两比较差异均有统计学意义(P<0.05)。随访期间无TOLF复发。结论 UBE技术是治疗单节段TOLF的一种安全有效方法,但远期疗效有待进一步研究明确。

Objective To investigate the safety and effectiveness of unilateral biportal endoscopy (UBE)technique in the treatment of single-segment thoracic ossification of ligamentum flavum (TOLF).Methods Between August 2020 and December 2021,11 patients with single-segment TOLF were treated with UBE technique.There were6 males and 5 females,with an average of 58.2 years (range,49-72 years).The responsible segment was T6,7in 1 case,T7,8in1 case,T8,9in 2 cases,T9,10in 2 cases,T10,11in 2 cases,and T11,12in 3 cases.Imaging examination showed that the ossification were located on the left side in 4 cases,on the right side in 3 cases,and on bilateral sides in 4 cases.The main clinical symptoms were chest and back pain or lower limb pain,all accompanied by lower limb numbness and fatigue.The disease duration ranged from 2 to 28 months (median,17 months).The operation time,postoperative hospital stay,and complications were recorded.Visual analogue scale (VAS) score was used to evaluate the chest and back pain and low limb pain,and Oswestry disability index (ODI) and Japanese Orthopedic Association (JOA) score were used to evaluate functional recovery before operation and at 3 days,1 month,3 months after operation,and last follow-up.The anteroposterior diameter of the coronal spinal canal was measured by CT before and after operation to evaluate the effect of surgical decompression.Results All operations were successfully completed.The operation time was 50-105 minutes,with an average of 80.0 minutes.No postoperative complication such as dural sac tear,cerebrospinal fluid leakage,spinal nerve injury,or infection occurred.The postoperative hospital stay was 2-5 days,with an average of 3.1 days.All incisions healed by first intention.All patients were followed up 6-22 months,with an average of 14.8 months.CT measurement at3 days after operation showed that the anteroposterior diameter of the spinal canal was (8.63±1.61) mm,which was significantly larger than that before operation[(3.67±1.37) mm](t=-12.181,P<0.001).The VAS score of chest and back pain and lower limb pain and ODI at each time point after operation were significantly lower than those before operation(P<0.05).The above indexes were further improved after operation,except that there was no significant difference between at 3 months after operation and at last follow-up (P>0.05),the differences between other time points were significant (P<0.05).There was no recurrence during the follow-up period.Conclusion UBE technique is a safe and effective method to treat single-segment TOLF,but its long-term effectiveness needs to be further studied.