经后路椎弓根截骨环形减压内固定治疗胸椎后纵韧带骨化的疗效观察  

The circumferential decompression by posterior transpedicular osteotomy and segmental instrumentation with interbody fusion for thoracic ossification of posterior iongitudinal ligament

作　　者：庄青山[1] 伦登兴[1] 徐兆万[1] 隋国侠[1] 冀旭斌[1] 刘大勇[1] 

机构地区：[1]潍坊市人民医院脊柱外科,山东省261041

出　　处：《中华医学杂志》2016年第15期1196-1200,共5页National Medical Journal of China

摘　　要：目的 观察经后路椎弓根截骨环形减压内固定治疗胸椎后纵韧带骨化（T-OPLL）的疗效.方法 2012年5月至2015年6月潍坊市人民医院脊柱外科16例T-OPLL患者;根据T-OPLL的长度及类型,设定不同的截骨范围,采用经椎弓根截骨环形减压术,一次手术从后方完整切除胸髓前方骨化的后纵韧带;统计发病节段、临床表现、手术并发症、疼痛视觉评分（VAS）、日本骨科协会（JOA）评分系统及Frankel分级.结果 随访时间26～47（31.5±6.7）m;手术时间190 ～ 310（261.6±51.3） min,出血量600～2 100（980±371） ml;所有患者均完全切除钙化的后纵韧带.术后1周,术后3、12个月、终末随访VAS评分分别为（4.2±0.2）、（2.7±0.1）、（2.4±0.2）、（2.0±0.1）分;术前与术后3个月3组之间差异有统计学意义（P＜0.05）;术前、术后3、12个月及终末随访的JOA评分分别为（4.2±1.7）、（7.8±2.5）、（8.5±2.7）、（9.0±1.0）分,总改善率为72％±8％.术前、术后3及12个月差异有统计学意义（P＜0.05）.术后所有患者的Franke1分级均有1或2级改善,无内固定松动、断钉、断棒等相关并发症.结论 经后路椎弓根截骨环形减压可以完整切除硬脊膜腹侧钙化的T-OPLL;是一种安全、有效、可行的方法,并能够完全切除脊髓前方钙化的后纵韧带.Objective To observe the efficacy of the circumferential decompression with posterior transpedicular osteotomy and segmental instrumentation with interbody fusion for thoracic ossification of posterior Iongitudinal ligament （T-OPLL）.Methods From May 2012 to June 2015,16 consecutive patients underwent posterior transpedicular osteotomy and segmental instrumentation with interbody fusion.Osteotomy range was depended by length and types of OPLL.Patient＇s data included level,clinical presentation,blood loss,length of surgery,complications,VAS,JOA,and Frankel grading system before and after the surgery.All data were collected,retrospectively.Results The follow-up period was （30 ± 19） months （range from 12 to 50 months）.The operation time was （261.6 ±51.3） min （range from 190 to 310 min）.The blood loss was （980.3 ± 370.5） ml （range from 600 to 2 100 ml）.All patients were well treated with posterior compression and segmental instrumentation with interbody fusion.The VAS score was （4.2 ± 0.2） in all patients at a week,improving to （2.7 ± 0.1） points at 3 months,（2.4 ± 0.2） at 1 year,and （2.0 ± 0.1） at last fellow-up.The statistical analysis of the results showed a significant improvement of pain at 3 months （P ＜ 0.05） when compared to the preoperative status.The preoperative JOA score was （4.2 ± 1.7） in all patients,improving to （7.8 ± 2.5） points at 3 months,（8.5 ± 2.7） at 1 year,and （9.0 ± 1.0） at last fellow-up.The mean recovery rate for the total JOA score was （72％ ±8％）.Differences in the overall JOA Scores showed significant postoperative improvement.Frankel grade improved by either 1 or 2 grades in 16 patients at the last follow-up.None of the patients showed any signs of instrument migration or failure during follow-up.Conclusion The results suggested that the procedure achieved a total resection of the ossified posterior longitudinal ligament.The treatment method with posterior transpedicular osteotomy and circumferential deco

关 键 词：骨化 后纵韧带 减压术 外科 内固定器 

分 类 号：R687.3[医药卫生—骨科学]