经皮后路脊柱内镜手术治疗胸椎黄韧带骨化症2年疗效随访研究  

Therapeutic Effects of Percutaneous Posterior Spinal Endoscopic Surgery for Thoracic Ossification of the Ligamentum Flavum:a 2-year Follow-up Study

作　　者：齐慧 吴彬彬[2] 占恭豪[2] 杨明浩 范林玉 赵伟 俞缘阳 林福清[1] Qi Hui;Wu Binbin;Zhan Gonghao(Department of Anesthesiology, Shanhai Tenth People’s Hospital, Shanghai 200040, China;不详)

机构地区：[1]上海市第十人民医院麻醉科,上海200040 [2]温州医科大学附属第二医院疼痛科,温州325027 [3]三峡大学第三临床医学院/国药葛洲坝中心医院骨外科,宜昌443003

出　　处：《中国微创外科杂志》2020年第8期717-720,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：温州市科技局课题(Y20160392)。

摘　　要：目的探讨经皮后路脊柱内镜手术治疗胸椎黄韧带骨化症的安全性和临床疗效。方法回顾性分析2014年12月~2017年12月第一诊断为“胸椎黄韧带骨化症”接受经皮后路脊柱内镜手术并完成2年随访的53例资料,手术节段T2/3~T11/12。记录术前和术后1天、1周、1个月、3个月、6个月、1年、2年胸背部和下肢疼痛视觉模拟量表(Visual Analogue Scale,VAS)评分以及Oswestry功能障碍指数(Oswestry Disability Index,ODI),术前、术后3个月和2年进行日本骨科协会(Japanese Orthopaedic Association,JOA)评分评估。结果中位手术时间90(60~150)min,无神经根损伤、硬膜囊撕裂或感染,术后住院时间8(4~22)d。术后各时间点胸背部和下肢痛VAS评分以及ODI较术前显著降低,JOA评分显著升高(P均=0.000)。按JOA术后恢复率,术后3个月优12例,良24例,可12例,差5例,优良率67.9%;术后2年优23例,良23例,可7例,差0例,优良率86.8%(χ^2=5.386,P=0.020)。均无须二次内镜或开放手术。结论经皮后路脊柱内镜手术治疗胸椎黄韧带骨化症安全有效,但还需大样本随机对照研究进一步证实。Objective To explore the safety and clinical outcome of percutaneous posterior spinal endoscopic surgery for thoracic ossification of the ligamentum flavum(TOLF).Methods Fifty-three patients who diagnosed as having TOLF and received percutaneous posterior spinal endoscopic surgery from December 2014 to December 2017 and followed up for 2 years were retrospectively reviewed.The distribution of the surgery levels was from T2/3 to T11/12.The Visual Analogue Scale(VAS)of thoracic and leg pain,and Oswestry Disability Index(ODI)were assessed at pre-operation,postoperative 1-day,1-week,1-month,3-month,6-month,1-year and 2-year,respectively.In addition,the Japanese Orthopaedic Association(JOA)score was used to assess the recovery at pre-operation,postoperative 3-month and 2-year,respectively.Results The median operation time was 90 min(range,60-150 min).No complication such as epidural tear,nerve root injury,or infection was reported.The median hospital stay was 8 d(range,4-22 d).As compared to pre-operation,the postoperative thoracic and leg pain VAS and ODI scores were significantly decreased,and the JOA scores were increased at all postoperative follow-up time points(all P=0.000).Twelve cases were evaluated as“excellent”,24 cases were“good”,12 cases were“fair”and 5 cases were“poor”at postoperative 3-month,the excellent-to-good rate being 67.9%.In addition,there were 23 cases“excellent”,23 cases“good”,and 7 cases“fair”at postoperative 2-year,the excellent-to-good rate being 86.8%(χ^2=5.386,P=0.020).No second open-surgery was required.Conclusion The percutaneous posterior spinal endoscopic surgery is a safe and effective therapy for TOLF,but further randomized clinical research is needed to make a confirmative conclusion.

关 键 词：经皮后路脊柱内镜 胸椎黄韧带骨化 

分 类 号：R68[医药卫生—骨科学]