摘要
[目的]比较双侧开槽椎管扩大Arch钢板固定成形术与传统的后路全椎板切除术治疗胸椎黄韧带骨化症(OLF)的临床疗效。[方法]回顾分析2014年1月～2017年1月于本院诊断为OLF并手术的患者54例,其中25例接受椎管成形术,29例接受椎板切除术。采用SF-36生活质量评分、下肢-躯干-膀胱JOA评分评定临床效果,并行CT和MRI影像测量。[结果]两组术中出血量、手术时间的差异无统计学意义(P>0.05)。椎管成形组均未发生硬膜损伤,而椎板切除组中有5例患者发生了术中硬脊膜撕裂以及术后脑脊液漏。两组患者末次随访时的SF-36评分均显著高于术前,差异有统计学意义(P<0.05)。术前两组间SF-36评分的差异无统计学意义(P>0.05),但末次随访时椎管成形组明显优于椎板切除组,差异有统计学意义(P<0.05)。椎管成形组患者神经功能恢复率为88%(22/25),椎板切除组患者神经功能恢复率为86%(25/29),差异无统计学意义(P>0.05)。影像学评估显示两种术式均可以达到显著的减压效果,且两种手术方式在存在与不存在硬脊膜粘连、骨化的患者均可以达到相同的减压效果(P>0.05)。[结论]胸椎椎管扩大成形术与传统椎板切除术均可有效治疗胸椎黄韧带骨化症,但胸椎椎管扩大成形术可以减少硬脊膜撕裂、脑脊液漏等并发症的发生,提高患者生活质量。
[Objective] To compare the clinical outcomes of expansive laminoplasty combined with arch plate fixation versus total laminectomy for thoracic ossification of ligamentum flavum（OLF）. [Methods] A retrospective study was conducted on54 patients who underwent surgical treatment for thoracic ossification of ligamentum flavum from January 2014 to January 2017 in our hospital. Of them, 25 patients received expansive laminoplasty combined with arch plate fixation, while the remaining 29 patients had total laminectomy. The SF-36 living quality score and lower extremity-trunk-bladder JOA score were used for assessment of clinical consequences, additionally, radiographic measurements were conducted. [Results] There were no significant differences regarding to intraoperative blood loss and operation time between the two groups（P〈0.05）. No any patients had dural injuries in the laminoplasty group, whereas 5 patients in the laminectomy group got intraoperative dural tear and cerebrospinal fluid leakage postoperatively. The SF-36 score significantly increased at the latest follow up in both group compared with those before operation（P〈0.05）. The laminoplasty group was significantly superior to the laminectomy group at the latest follow up（P〈0.05）, although no a significant difference in SF-36 score between them before operation（P〉0.05）. Based on lower extremity-trunk-bladder JOA score, the nerve function recovery rate proved 88%（22/25） in the laminoplasty group, whereas86%（25/29） in the laminectomy group, without a statistically significant difference between them（P〉0.05）. In term of imaging evaluation, both laminoplasty and laminectomy achieved considerable decompression of spinal canal, which were comparable with or without dura-ossification adhesion（P〉0.05）. [Conclusion] Both posterior expansive laminoplasty and total laminectomy are effective treatment for thoracic OLF. By comparison, the laminoplasty takes benefits of reducing risk of dural injuries and cerebrospinal fluid leakage, improving living quality over the laminectomy.
作者
马君
林涛
吉喆
周许辉
MA Jun;LIN Tao;JI Zhe;ZHOU Xu-hui(Department of Spinal Surgery,Changzheng Hospital,Shanghai 200003,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2018年第21期1932-1937,共6页
Orthopedic Journal of China
关键词
胸椎黄韧带骨化
硬脊膜粘连骨化
椎管成形术
椎板切除术
thoracic ossification of ligamentum flavum
dura-ossification adhesion
laminoplasty
laminectomy
