摘要
【摘要】目的探讨半关节全椎板分段切除减压对连续多节段重度胸椎黄韧带骨化症的治疗效果及手术技巧。方法2008年1月至2010年1月，26例连续多节段重度胸椎黄韧带骨化症患者接受全椎板分段切除减压治疗，其中男11例，女15例；平均5l-2（43～69）岁。所选患者均为连续多节段胸椎黄韧带骨化，其中T5-8椎3例，T5-9椎2例，T6-9椎2例，T6-11椎2例，T7-10椎3例，T7-11椎3例，T8-11椎8例，T7一T12椎2例，T8～L1椎1例。采用改良JOA评分法（11分）和Nurick分级评价神经减压效果。结果本组患者手术均安全顺利完成，减压节段3—5个，平均3．7个。手术时间3．0～5．5h，平均4．1h，出血量900～2100ml，平均1300ml。术后出现脑脊液漏21例。术后6例发生短暂脊髓损伤加重，另1例术后症状改善不明显，但未加重。未发生切口感染。随访12～36个月，平均24．4个月。术后JOA评分与术前比较有较大改善，评分术前为3．00±2．32，术后2周为7．23±2．18，差异有统计学意义（P〈0．05）。Nurick分级与术前比较，9例较术前提高3级，12例提高2级，4例提高l级，1例未提高。末次随访时无加重病例。结论半关节全椎板分段切除减压治疗连续多节段重度胸椎黄韧带骨化症安全、可靠，疗效满意。应特别注意其手术技巧。
Objective To investigate the clinical outcomes and surgical techniques of hemi-articular total laminectomy and segmental decompression for severe continuous multi-segmental thoracic ossification of ligamentum flavum （ OLF ）. Methods From January 2008 to January 2010, 26 patients with severe continuous multi-segmental thoracic OLF underwent the treatment of total laminectomy and segmental decompression. There were 11 males and 15 females, whose mean age was 51.2 years old （ range; 43 -69 years ）. Ts.s OLF occurred in 3 cases, T5.9 in 2 cases, Tt.9 in 2 cases, T6-11 in 2 cases, T7-10 in 3 cases, T7-11 in 3 cases, T8-11 in 8 cases, T7-12 in 2 cases and T8-L1 in 1 case. The surgical outcomes were evaluated using the improved Japanese Orthopaedic Association （ JOA ） scoring system （ 11 scores ） and the Nurick classification. Results The operation procedures were carried out successfully in all patients. There were 3.7 decompressed segments on average （ range; 3-5 ）. The mean operative time was 4.1 hr （ range; 3.0-5.5 hr ）. The mean blood loss was 1300 ml （ range; 900-2100 ml ）. The postoperative cerebrospinal fluid leakage occurred in 21 cases. 6 patients had temporarily aggravated spinal cord injuries after the operation. The symptoms of another patient were not obviously improved, but did not get worse. No superficial wound infection was found. All patients were followed up for an average period of 24.4 months （ range; 12-36 months ）. The preoperative JOA score was 3.00=~2..32 points, which was significantly improved to 7.23=~2..18 points at the 2nd week after the operation, and the differences were statistically significant （ P〈0.05 ）. According to the Nurick classification, the results were improved by 3 grades in 9 cases when compared with that preoperatively, 2 grades in 12 cases and 1 grade in 4 cases, with no improvement in 1 patient. The symptoms of all patients did not get worse in the latest follow-up. Conclusions Hemi-articular total laminectomy and segmental decompression is a safe and effective surgical procedure for severe continuous multi- segmental thoracic OLF, with satisfactory clinical results. Special attention should be paid to the surgical techniques.
出处
《中国骨与关节杂志》
CAS
2014年第1期20-24,共5页
Chinese Journal of Bone and Joint
关键词
椎板切除术
减压术
外科
黄韧带
胸椎
黄韧带骨化
Laminectomy
Decompression, surgical
Ligamentum flavum
Thoracic vertebrae
Ossification of ligamentum flavum （ OLF ）
