椎板截骨原位回植固定术在多节段胸椎黄韧带骨化症中的应用  

Thoracic laminectomy and replantation in situ combined with fixation in the treatment of multiple level ossification of the ligamentum flavum

作　　者：霍喜卫[1] 李海涛[1] 王飞[1] 周玉军[1] 李东风[1] 胡成栋[1] 刘法敬[1] 

机构地区：[1]河北省邯郸市中心医院骨二科,056001

出　　处：《中国矫形外科杂志》2013年第1期18-22,共5页Orthopedic Journal of China

摘　　要：[目的]观察胸椎椎板截骨原位回植+微型钛板固定术在治疗连续多节段胸椎黄韧带骨化症(multi-levelof ossification of the ligamentum flavum,M-OLF)的临床疗效。[方法]采用经关节突内侧截骨法将椎板及其附属结构整块取下,将骨化黄韧带清除后再将椎板原位回植,并辅以微型钛板双侧固定,完成椎管减压及重建。共15例患者获得完整临床随访,其中男6例,女9例;年龄41～69岁,平均55.7岁,两节段黄韧带骨化者3例,三节段10例,四节段2例。记录并分析术后神经功能恢复情况及手术节段曲度变化。[结果]所有患者均无脊髓及神经根损伤等情况发生。随访时间23～46个月,未出现内固定物松动、脱出及椎板移位。JOA评分(11分法)由术前的(5.7±1.5)恢复至术后3个月的(8.8±2.5)及末次随访时的(9.3±2.7),差异具有统计学意义(P<0.01)),神经功能改善率为(67.9±13.5)%。Cobb角由术前的(13.4±4.1)°增加至术后3个月的(14.1±3.9)°及末次随访的(15.2±4.6)°,术后与术前比较均无显著性差异(P>0.05),局部Cobb平均增加(1.8±1.1)°。术中共发生脑脊液漏4例,经缝合及人工硬脊膜覆盖后愈合良好;术后1例出现下肢深静脉血栓,1例发生肺部感染,经积极治疗后均好转出院。[结论]胸椎椎板截骨原位回植+微型钛板固定术是治疗M-OLF的一种有效术式,它可避免术后瘢痕组织对脊髓产生再次压迫,同时也可有效防止胸椎后凸畸形的发生。[ Objective] To investigate the clinical outcomes and surgical safety of thoracic laminectomy and replantation with miniplate fixation in the treatment of muhi - level of ossification of the ligamentum flavum. [ Methods ] A retrospective study was performed in 15 patients who had multi - level of ossification of the ligamentum flavum received the procedure of tho- racic laminectomy and replantation with miniplate fixation, which contained the steps of laminae osteotomy from the medial facet and replantation in situ after the ossified flavum ligament were extirpated clearly, and then the laminae were fixed bilaterally by miniplate. There were 6 male and 9 female patients ranging from 41 - 69 years （ mean, 55.7 years） . The ossified ligamentum flavum involved two segments in 3 patients, three segments in 10 cases and four segments in 2 cases. The neurological improvement and sagittal alignment changes postoperatively were recorded and analyzed. [ Results ] All patients were successfully operated. After a average 34.4 month follow -up, the mean score according to the Japanese Orthopedic Association （JOA） scale improved from （ 5.7 ± 1.5 ） preoperatively to （ 8.8± 2. 5 ） at 3 months after the operation and （ 9.3 ± 2.7 ） at the final follow - up （P 〈 0. 01 ）, with a mean recovery rate of （67.9 ± 13.5 ）%. The Cobb angle increased from （13.4 ± 4. 1 ）o preoperatively to （ 14. 1 ± 3.9 ） o at 3 months after the operation and （ 15.2 ± 4. 6） o at the final follow - up （ P 〉 0. 05 ） , the local kyphotic in the treated area increased by only （ 1. 8± 1. 1 ） No patient required additional surgery due to spinal canal re - ohstruction and pro- gressive spinal deformity. Cerebrospinal fluid leakage occurred in 4 patients, and healed well after being repaired. A lung intec- tion and a deep vein thrombosis occurred in 1 patient respectively, and they were safely discharged after a regular treatment. [ Conclusion ] Thoracic laminectomy and replantation with miniplate fixation

关 键 词：黄韧带骨化 胸椎 椎板回植 疗效分析 

分 类 号：R687.3[医药卫生—骨科学]