选择性颈椎板开窗黄韧带切除治疗黄韧带肥厚症  

Selective fenestration lamina of cervical vertebral lamina to excise ligamentum flavum for treating hypertrophic ligamentum flavum

作　　者：占蓓蕾[1] 叶舟[1] 

机构地区：[1]衢州中心医院骨科,浙江衢州324000

出　　处：《中国骨伤》2009年第10期741-743,共3页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨应用选择性颈椎板开窗黄韧带切除治疗黄韧带肥厚症的手术方法与效果。方法:自1998年3月至2007年5月,采用颈椎板开窗黄韧带切除治疗21例黄韧带肥厚症患者,其中男14例,女7例;年龄37～76岁,平均52.2岁。发病时间:5h～25年,平均3年10个月。发病原因:无诱因突然发病4例,缓慢发病10例,外伤后发病7例。术后通过JOA评分与影像学检查评价手术疗效。结果:所有病例均获得随访,时间3个月～7年6个月,平均2年6个月。影像学检查:椎管矢状径增加,椎管横截面面积明显扩大,脊髓膨隆良好。术后行走能力增强,大部分患者手指活动灵活性改善,握力增加,用筷进食准确性提高,肢体麻木和胸腰部束带感有不同程度减轻,术前大小便功能障碍者均有不同程度改善。术前JOA评分5～16分,平均(11.48±2.94)分;术后JOA评分7～17分,平均(13.81±2.98)分,改善率平均45.86%,手术前后JOA评分有统计学差异(t=3.51,P<0.05)。其中优13例,良5例,中2例,差1例。结论:选择性颈椎板开窗黄韧带切除术,手术操作简便、创伤小,只要适应证选择合理,可以使椎管获得有效的减压。Objective：To explore operative method and clinical effect of selective fenestration of cervical vertebral lamina to excise ligamentum flavum for treating hypertrophic ligamentum flavum（HLF）. Methods：From March 1998 to May 2007,21 patients（14 males and 7 females）with HLF were reviewed retrospectirely,whose age was from 37 to 76 years with an average of 52.2 years. The history of HLF was from 5 h to 25 years with an average of 3 years and 10 months. Reason of onset：4 cases were no inducement,10 cases were slow moving,and 7 cases caused by injury. The operative effect was assessed according to JOA scores and radiologic results. Results：All patients were followed up with an average of 2.5 years（ranging from 3 months to 7.5 years）. Radiologic results：sagittal diameter of vertebral canal and trans.sec. area increased and spinal cord were well than preoperative status. The majority of cases got stronger in the walking,improvement in the fingers mobility and holding power and using chopsticks,abatement in the limbs numb and thoracic waist zonesthesia,amelioration in the urination and defecation functional disturbance than preoperative symptom. The JOA scoring was 5-16 scores with an average of 11.48±2.94 before operation,and 7-17 scores with an average of 13.81±2.98 after operation. That results had statistical significance between before and after operation （t=3.51,P0.05）. There were 13 cases excellent （improvement rate more than 75%）,5 cases good（improvement rate in 50%-74%）,2 cases fair（improvement rate in 25%-49%）,1 case poor（improvement rate less than or equal to 24%）with an average improvement rate of 85.2%. Conclusion：It is simple in the operative procedure and tiny in trauma in treatment for hypertrophic ligamentum flavum with selective fenestration of cervical vertebral lamina to excise ligamentum flavum. The method can obtain effective decompression for vertebral canal but choice of indication must be reasonable.

关 键 词：退行性疾病 黄韧带 颈椎 外科手术 

分 类 号：R686.5[医药卫生—骨科学] R681.53[医药卫生—外科学]