后路360°环形减压椎弓根螺钉内固定治疗胸椎后纵韧带骨化  

Application of 360 degree circular decompression and transpedicle screw fixation in the treatment of ossification of thoracic posterior longitudinal ligament by posterior approach

作　　者：杨保辉[1] 秦杰[1] 李浩鹏[1] 贺西京[1] 张纯[1] 

机构地区：[1]西安交通大学第二附属医院骨科,陕西西安710004

出　　处：《中国骨伤》2016年第2期167-171,共5页China Journal of Orthopaedics and Traumatology

摘　　要：目的 ：探讨后路360°环形减压椎弓根螺钉内固定治疗胸椎后纵韧带骨化临床效果。方法 ：2009年12月至2013年11月采用后路360°环形减压椎弓根螺钉内固定治疗胸椎后纵韧带骨化18例,男8例,女10例;年龄32~67岁,平均51岁,术前常规行X线,CT及MR检查,合并黄韧带骨化4例;上胸段5例,中下段胸椎13例;局限型5例,节段型4例,连续型6例,混合型3例;应用后方＂揭盖式＂椎管减压＋硬膜前方后纵韧带切除（或塌陷）的环形减压植骨融合内固定的方法进行治疗。记录手术时间、出血量及并发症等一般情况;采用JOA（11分法）评分评价术前、术后第2天及末次随访的神经系统功能,并计算神经功能改善率;采用Epstein-Schwall的标准评定手术疗效。结果：手术时间3~6 h,平均4.2 h;术中出血量800~4 000 ml,平均1 800 ml。所有患者获得随访,时间6个月~3年,平均1.8年。JOA评分由术前的4.30±2.60提高到术后第2天的7.60±2.40,末次随访的7.80±1.90;末次随访与术后第2天JOA评分差异无统计学意义（t=0.28,P=0.78）,与术前差异有统计学意义（t=4.61,P〈0.001）;术后第2天神经功能改善率为74%,末次随访时神经功能改善率为71%。按Epstein-Schwall的标准评定手术疗效：优4例,良10例,改善3例,差1例。4例发生脑脊液漏,肋间神经麻痹或疼痛3例,切口浅表感染1例。3例术后第2天查体神经功能加重,末次随访时2例恢复,1例无变化。所有病例植骨显示融合,未见内固定松动及断裂等。结论：后路360°环形减压椎弓根螺钉内固定可完成不同骨化类型的胸椎后纵韧带骨化的切除,且可取得较为良好的临床效果。Objective：To investigate the clinical effects of 360 degree circular decompression and transpedicle screw fixation to treat the ossification of thoracic posterior longitudinal ligament by posterior approach. Methods：From December 2009 to November 2013,18 patients with ossification of thoracic posterior longitudinal ligament ossification were treated with 360 degree circle decompression and transpedicle screw fixation by posterior approach. There were 8 males and 10 females,ranging in age from 32 to 67 years old,with an average of 51 years old. Four patients were accompanied with ligamentum flavum ossification. Longitudinal ossifications in 5 cases were located in the upper thoracic vertebra and 13 cases in the middle and lower thoracic vertebra. Five cases were typical type,4 cases were segmental type,6 cases were continuous type and 3 cases were mixed type. All the patients had the posterior spinal canal decompression combined with longitudinal ligament resection,interbody fusion with bone graft and internal fixation surgeries. The operation time,blood loss and complications were recorded.JOA score were applied to evaluate the neurological function recovery pre surgery,2 days post surgery and the latest follow up.The surgery effects were evaluated by Epstein-Schwall method. Results：The operation time ranged from 3 to 6 hours（mean,4.2 hours）. The blood loss ranged from 800 to 4 000 ml（mean,1 800 ml）. All the patients were followed up,and the duration ranged from 6 months to 3 years,with a mean of 1.8 years. The JOA score increased from preoperative 4.30±2.60 to 7.60±2.402 days after surgery,and 7.80±1.90 at the latest follow up（t=4.61,P〈0.001）. The JOA scores between 2 days after surgery and the latest follow up had no significant differences（t =0.28,P =0.78）. The neurological recovery rate was 74% 2 days after surgery and 71% at the latest follow up. There were 4 cases got an excellent result,10 good,3 fair and 1 poor according to Epstein-Schwall evaluation method. Four patients had ce

关 键 词：胸椎 椎管狭窄 骨化 后纵韧带 内固定器 

分 类 号：R744[医药卫生—神经病学与精神病学]