胸椎黄韧带骨化症手术治疗方法的选择  

Choose of operation method in patients with ossification of thoracic ligamentum flavum

作　　者：赵光宗[1] 刘瑶[1] 张华朋[1] 

机构地区：[1]山东省潍坊市益都中心医院骨一科,262500

出　　处：《中国医师进修杂志》2012年第2期19-21,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨胸椎黄韧带骨化症的发病机制及手术方法。方法回顾性分析经手术治疗的56例胸椎黄韧带骨化症患者的影像学与临床资料。所有患者采用全椎板切除加后外侧融合术，全椎板切除方法包括整块全椎板切除术与椎板分解切除术；手术疗效采用日本骨科协会（joA）评分法进行评价。结果56例患者共累及237个节段，以下胸段最为多见，占57．4％（136／237）。术后随访18～70（25．00±11．56）个月。根据最后一次随访结果，56例患者中优25例，良20例，无变化6例，差5例，优良率80．4％（45／56）。根据骨化巢形态，各型手术优良率分别为外侧型83．3％（5／6）、弥漫型82．4％（14／17）、厚结节型78．8％（26／33）。应用整块全椎板切除术24例，其中4例厚结节型中有2例术后脊髓损伤加重；应用椎板分解切除术32例，其中29例厚结节型中仅2例术后脊髓损伤加重。结论局部应力因素是胸椎黄韧带骨化形成的主要原因之一；全椎板切除加后外侧融合术是治疗本病的理想手术方法，其中外侧型、弥漫型可采用整块全椎板切除术，而厚结节型采用椎板分解切除术更为安全。Objective To investigate the pathogenesy and operation method in patients with ossification of thoracic ligamentum flavum. Methods The imaging and clinical data of 56 patients who underwent lamineetomy combined with posteroatera] fusion were studied retrospectively. The method of laminectomy included enbloc laminectomy and decomposed laminectomy. Postoperative outcomes were evaluated according to a recovery scale in terms of JOA score. Results The patients were followed up for 18-70 （25.00 ± 11.56 ） months. There were a total of 237 ossified segments in this series, 57.4% （ 136/237 ） located in lower thoracic segments. According to the configuration of ossification on CT scans, lateral type occurred in 6 patients, diffuse type in 17 patients and thickened nodular type in 33 patients. All patients with lateral type and majority of patients with diffuse type were treated with enbloc laminectomy, and the rate of fineness of postoperative outcome was 83.3% （5/6）, 82.4% （14/17） respectively. Most of the patients with thickened nodular type were treated with decomposed laminectomy, and the rate of fineness of postoperative outcome was 78.8% （26/33）. Four patients with thickened nodular type were performed with enbloc laminectomy, 2 of them resulted in deteriorated myelopathy. Twenty-nine patients with thickened nodular type were performed with decomposed lamineetomy, however, only 2 of them resulted in worse outcomes. Conclusions The pathogenesis of ossification of thoracic ligamentum flavum is mainly due to the localized mechanical stress. Lamineetomy combining with lateral fusion may be the ideal method for the treatment of this condition. Furthermore, enbloc laminectomy is suitable for the patients in lateral type and diffuse type according to the configuration of ossifications. For the thickened nodular type, decomposed laminectomy is favorable.

关 键 词：骨化 后纵韧带 减压术 外科 椎板切除术 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]