| 王文涛,段 琨,王欣文,刘团江,吴起宁,郝定均,刘继军.椎板薄化分解结合根黄通道治疗单节段胸椎黄韧带骨化合并脊髓损伤[J].,2017,17(36):7137-7140 |
| 椎板薄化分解结合根黄通道治疗单节段胸椎黄韧带骨化合并脊髓损伤 |
| Per pedicel-ossified Ligament Flavmn Tunnel combined Laminar Thinned-segmented Decompression for the Treatment of Single-level Thoracic Ossification of Ligamentum Flavum with Spinal Injury |
| 投稿时间：2017-03-26 修订日期：2017-04-21 |
| DOI：10.13241/j.cnki.pmb.2017.36.032 |
| 中文关键词: 胸椎黄韧带骨化症 薄化分解 根黄通道 |
| 英文关键词: Thoracic ossification of ligament flavum Per pedicel-ossified ligament flavmn tunnel Laminar thinned-segmented |
| 基金项目:陕西省社会发展攻关基金项目（2016SF-072） |
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| 中文摘要: |
| 摘要 目的：探讨椎板薄化分解结合根黄通道治疗单节段胸椎黄韧带骨化症（OLF）合并脊髓损伤的临床疗效及安全性。方法：回顾性分析2010年6月-2014年12月我院接受椎板薄化分解结合根黄通道治疗并获得随访的52例单节段胸椎OLF，其中男34 例，女18例；手术时年龄55~72 岁，平均63.8岁。节段分布: T10/11 21 例，T11/12 18 例，T9/10 8 例，T8/9 5 例。记录手术时间，术中出血量，比较术前及末次随访时JOA，ASIA神经功能评分变化，通过CT及MRI扫描观察椎管减压及植骨融合情况。结果：52例患者均随访12月。本组患者手术间120±24 min，出血量240±60 mL。括约肌功能JOA评分、下肢运动功能JOA评分、ASIA运动功能评分、ASIA感觉能评分分别从术前1.56±0.78、1.98±0.66、68.3±9.86、79.2±10.23提高到术后12月2.67±0.56分、3.62±0.82分、93.5±15.82、102.3±21.65，具有统计学意义（P<0.01）。按Epstein和SchwaH评分标准，优37例，良13例，可1例，差1例；优良率92.3%。术后3例发生神经症状加重，给予营养神经药物治疗后6月恢复到术前水平；5例发生脑脊液漏，行保守治疗治愈。CT提示减压彻底，植骨融合，未见内固定失败。结论：椎板薄化分解结合根黄通道治疗单节段胸椎OLF 减压彻底，侵袭小，手术安全性可靠，疗效确切。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the feasibility and effect of per pedicel-ossified ligament flavmn tunnel combined laminar thinned-segmented decompression for treatment of single-level thoracic ossification of ligamentum flavum (OLF) with spinal injury. Methods: A total of 52 patients with single-level thoracic ossification of ligamentum flavum with myelopath underwent per pedicel -ossified ligament flavmn tunnel combined laminar thinned-segmented decompression technique between June, 2010 and December 2014 were retrospective analysis. Among these 52 cases, there were male 34 cases, female 18 cases with a mean age of 63.8 years (range 55 to 72). Segmental distributions was as follows: 21 cases of T10/11, 18 cases of T11/12, 8 cases of T9/10, 5 cases of T8/9. The perioperative data such as operative time，blood loss volume, complications were recorded. The modified JOA, ASIA nerve function score. CT and MRI scanning, decompression and bone graft fusion were used to measure the outcomes. Results: All 52 cases were followed up for 12 months. The mean operative time was 120±24 min. blood loss was240±60 mL, the mean JOA sphincter function score was 1.56±0.78 and 2.67±0.56, the JOA motor function score was 1.98±0.66 and 3.62±0.82, the mean ASIA sensory score was 68.3±9.86 and 93.5±15.82, the average ASIA motor score was 79.2±10.23 and 102.3±21.65 before surgery and at the final follow-up. According to Epstein and Sehwall criteria, the clinical outcomes were excellent in 37 cases, good in 13 cases．fair in 1 cases and bad in 1 cases, and the excellent and good rate was 92.3%, CT shows all cases ossification of ligamentum flavum were radical resection and got bone fusion at the last follow up time, no radiological sign of instrumentation failure at the final follow-up. Postoperative complications included spinal cord injury (3 cases), leakage of cerebrospinal fluid(5 cases). Conclusion: The per pedicel-ossified ligament flavmn tunnel combined laminar thinned-segmented decompression is safe and effective for single-level thoracic ossification of ligamentum flavum with spinal injury. |
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