层揭薄化法减压治疗胸椎黄韧带骨化合并脊髓病  

Laminar shelling decompression for treatment of thoracic ossification of ligamentum flavum with spondylotic myelopathy

作　　者：雪原[1] 王沛[1] 马信龙[1] 郑永发[1] 张义修[1] 李杨[1] 邰杰[1] 孙景成[1] 郭世绂[1] 

机构地区：[1]天津医科大学总医院骨科,300052

出　　处：《中华骨科杂志》2006年第3期161-164,共4页Chinese Journal of Orthopaedics

摘　　要：目的介绍层揭薄化法减压治疗胸椎黄韧带骨化合并脊髓病,并探讨其疗效。方法胸椎黄韧带骨化合并脊髓病102例,男63例,女39例;年龄33￣71岁,平均49.7岁。脊髓病位于上胸段33例,中胸段37例,下胸段32例。改良JOA下肢运动功能评分为1.206±0.958。术前存在感觉障碍99例;束带感73例;括约肌功能障碍77例,JOA括约肌功能评分为1.996±0.521。采用层揭法进行减压:第一层,切除椎板背侧皮质;第二层,以关节突关节面为深度标记铲除骨化组织;第三层,高速磨钻打磨使骨化组织呈蛋壳样;第四层,蚕食切除。结果减压2￣4个椎板,平均2.8个。全部病例随访3￣41个月,平均18.9个月。99例感觉障碍者完全恢复69例,部分恢复30例;73例束带感均完全消失;77例括约肌功能障碍者术后JOA评分为2.632±0.407,和术前比较差异有统计学意义(t=15.93,P<0.01)。术后JOA下肢运动功能评分为3.751±0.652,和术前比较差异有统计学意义(t=20.16,P<0.01),运动功能恢复率81.1%,疗效优良率94.1%。结论层揭薄化法减压具有对脊髓侵袭小的优点,术前脊髓神经压迫定位和术中病变椎体的定位是手术成功的前提。Objective To introduce laminar shelling decompression technique and to discuss its benefit for decompression of thoracic ossification of ligamentum flavum. Methods 102 patients were diagnosed as thoracic ossification of ligamentum flavum, 63 males and 39 females with an average age of 49.7 years （range, 33 to 71 years）. 99 cases suffered with sensation disturbance, 73 cases with constriction on trunk or lower limbs, 77 cases with sphincter dysfunction. The IMSOP Standard Neurological Classification of Spinal Cord Injury was applied for localized the level of thoracic spondylopathy. The JOA lower limb motor function standard and sphincter function standard were used to evaluate the ability of lower limb motion and sphincter function respectively. In the decompression the dorsal cortex of lamina was the first layer to resect, the facet joint surface indicate the depth for removing the second layer, then thinning the ossified tissue by shaving with the motor bur until it was somewhat lucent, Finally decompress the spinal canal by moth eaten manner. Results The mean decompression length was 2,8 lamina （2 to 4 lamina）, The mean follow-up du- ration was 18.9 months （3 to 41 months）. Among 99 sensation disturbance 69 totally recovered, 30 relived. 73 cases with the feel of constriction of trunk or lower limbs were completely recovered. Postoperative JOA sphincter function score was 2.632±0.407, comparing with the preoperation score, and the difference was significant （t=15.93, P〈 0.01）. Postoperative JOA motor function score was 3.751 ±0.657, comparing with the preoperation score, and the difference was significant （t=20.16, P〈 0.01）. Motor function recovery rate was 81.1%, and excellent and good rate was 94,1%. Conclusion In layers thining and shelling is preferable technique to decompress thoracic ossification of ligamentum flavum with sDondvlotic mvelonathv.

关 键 词：骨化 异位性 黄韧带 胸椎 脊髓压迫症 减压术 外科 

分 类 号：R687.3[医药卫生—骨科学]