经关节突入路治疗韧带骨化型胸椎管狭窄症  

EFFECTIVENESS OF TRANSARTICULAR APPROACH IN TREATING THORACIC SPINAL STENOSIS OF CALCIFIED LIGAMENT

作　　者：刘法敬[1] 申勇[1] 丁文元[1] 杨大龙[1] 杜伟[1] 

机构地区：[1]河北医科大学第三医院脊柱外科,石家庄050051

出　　处：《中国修复重建外科杂志》2011年第3期311-315,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的评价经关节突入路治疗后纵韧带骨化(ossifi cation of posterior longitudinal ligament,OPLL)型及黄韧带骨化(ossifi cation of ligamentum?avum,OLF)型胸椎管狭窄症的手术效果。方法回顾分析2006年l月-2008年3月采用经关节突后外侧入路治疗的35例单节段韧带骨化型胸椎管狭窄症患者临床资料。男12例,女23例;年龄40～67岁,平均58.6岁。病程8～48个月,平均16个月。单纯OLF 16例,单纯OPLL 11例,OPLL合并OLF 8例。病变节段:T2、3 4例,T3、4 3例,T4、5 1例,T6、7 3例,T7、8 1例,T8、9 2例,T9、10 5例,T10、11 9例,T11、12 7例。患者均行CT及MRI检查,以明确韧带骨化位置和胸椎管狭窄程度。术前日本骨科协会(JOA)评分为(6.1±1.3)分,Otani分级为优3例,良16例,可11例,差5例。结果患者均顺利完成手术,未出现神经损伤。术后切口均Ⅰ期愈合。5例术中发生脑脊液漏,经治疗后痊愈;1例术后6 h发生硬膜外血肿,肌力降至1级,行血肿清除术后3个月肌力恢复至4级。35例均获随访,随访时间1.5～2.6年,平均2.1年。患者临床症状均得到不同程度改善,随访期间未出现神经症状加重及脊柱不稳等情况。术后3个月JOA评分为(9.2±1.8)分,末次随访时为(9.6±2.3)分,术后各时间点与术前比较差异均有统计学意义(P<0.05);末次随访时与术后3个月比较差异无统计学意义(t=0.810,P=0.413)。末次随访时临床改善率为71.43%±18.20%。末次随访时根据Otani分级方法,获优12例,良15例,可6例,差2例,优良率为77.14%,与术前比较差异有统计学意义(u=2.711,P=0.007)。结论采用经关节突入路治疗韧带骨化型胸椎管狭窄症可获得较好的临床效果,术中需注意操作轻柔与准确,避免发生严重脊髓损伤。Objective To investegate the effectiveness of transarticular approach in treating thoracic spinal stenosis due to ossification of l igamentum flavum （OLF） and ossification of posterior longitudinal l igament （OPLL） at the same level. Methods A retrospective analysis was performed in 35 patients with single-level thoracic spinal stenosis of calcified l igament who accepted transarticular approaching operation between January 2006 and March 2008. There were 12 males and 23 females with an age range of 40-67 years （mean, 58.6 years）, including 16 cases of thoracic OLF, 11 cases of thoracic OPLL, and 8 cases of thoracic OPLL and OLF. The disease duration was 8-48 months （mean, 16 months）. The affected segments included T2, 3 in 4 cases, T3, 4 in 3 cases , T4, 5 in 1 case , T6, 7 in 3 cases , T7, 8 in 1 case , T8, 9 in 2 cases , T9, 10 in 5 cases , T10, 11 in 9 cases, and T11, 12 in 7 cases. CT and MRI were taken to definite the ossification position and the condition of thoracic spinal stenosis. The Japanese Orthopaedic Association （JOA） score was 6.1 ± 1.3 before operation. According to Otani scoring system, the results were excellent in 3 cases, good in 16 cases, fair in 11 cases, and poor in 5 cases. Results All operations were successful, and no nerve injury occurred. All incisions healed at stage I. Cerebrospinal fluid leakage occurred in 5 cases, and recovered after symptomatic treatment. One case had epidural hematoma 6 hours after operation, and the muscle strength recovered after symptomatic treatment. All cases were followed up 1.5-2.6 years （mean, 2.1 years） and the symptoms were improved in different degrees; no neurological symptoms deteriorated and spinal instabil ity occurred. The JOA score had a significant recovery at 3 months （9.2 ± 1.8） and at last follow-up （9.6 ± 2.3） when compared with preoperative value （P 〈 0.05）. At last follow-up, the rate of the cl inical improvement was 71.43% ± 18.20%. According to Otani scoring system at last follow-up, the re

关 键 词：胸椎管狭窄症 后纵韧带骨化 黄韧带骨化 经关节突入路 疗效分析 

分 类 号：R687.3[医药卫生—骨科学]