后路经皮内镜减压治疗胸椎黄韧带骨化症  

Posterior percutaneous endoscopic decompression for thoracic ossification of ligamentum flavum

作　　者：李岳飞 李瑞[1] 王光林[1] 任佳彬[1] 孙宁[1] 黄镇 毕经纬 胡鹏[1] 朱锴[1] 孙兆忠[1] LI Yue-fei;LI Rui;WANG Guang-lin;REN Jia-bin;SUN Ning;HUANG Zhen;BI Jing-wei;HU Peng;ZHU Kai;SUN Zhao-zhong(Department of Spinal Surgery,Affiliated Hospital,Binzhou Medical University,Binzhou 256600,China)

机构地区：[1]滨州医学院附属医院脊柱外科,山东省滨州市256600

出　　处：《中国矫形外科杂志》2020年第15期1390-1394,共5页Orthopedic Journal of China

摘　　要：[目的]探讨经皮脊柱内镜后侧入路减压治疗胸椎黄韧带骨化症(OLF)的临床疗效。[方法]回顾性分析2017年9月~2018年11月,本院采用经皮脊柱内镜后侧入路治疗23例胸椎OLF患者的临床资料。根据OLF病变部位分3组:单侧OLF 7例、双侧OLF 10例、融合OLF 6例。比较三组临床与影像资料。[结果]所有患者均未出现硬脊膜撕裂及血管损伤、切口感染、脑脊液漏等严重并发症。手术时间依次为单侧组<双侧组<融合组,差异有统计学意义(P<0.05),但在出血量及住院天数三组间差异无统计学意义(P>0.05)。随时间推移,三组患者VAS评分显著减少,而JOA评分显著增加(P<0.05)。相同时间点,VAS评分依次为单侧组<双侧组<融合组;JOA评分依次单侧组>双侧组>融合组。影像方面,三组患者术后OLF占比均较术前显著减少(P<0.05)。术后关节突关节缺损均<50%。[结论]经皮脊柱内镜下依据病变部位,主要经椎板行同侧或双侧减压,安全可靠,关节突关节缺损均<50%,不影响胸椎稳定性。[Objective]To explore the clinical outcomes of precise decompression under posterior percutaneous endoscopy for thoracic ossification of ligamentum flavum(OLF).[Methods]A retrospective analysis was conducted on 23 patients who underwent posterior percutaneous endoscopic decompression for thoracic OLF in our hospital from September 2017 to November2018.According to extent of OLF,7 patients had unilateral OLF,10 patients had bilateral OLF and 6 patients had fused OLF.The clinical and radiographic data were compared among the 3 groups.[Results]All patients in the 3 groups received successful surgeries without complications such as neurovascular injuries and dural tear.The operation time ranked significantly in a sequence of the unilateral group<the bilateral group<the fused group(P<0.05),although there were no statistical differences in intraoperative blood loss and hospital stay among three groups(P>0.05).As time went in follow-up period lasted for 13~27 months with an average of(17.53±9.78)months,VAS score significantly decreased,whereas JOA score significantly increased in all the 3 groups(P<0.05).At corresponding time points,VAS score ranked as the unilateral group<the bilateral group<the fused group,whereas JOA score arranged as the unilateral group>the bilateral group>the fused group.In term of radiographic assessment,the occupying ratio of OLF significantly decreased postoperatively in all the 3 groups compared with those before operation(P<0.05).However,the ratio of facet defect after operation was less than 50%in all patients of the 3 groups.[Conclusion]It is safe and effective that unilateral or bilateral accurate decompression under percutaneous endoscopy based on the lesion extent for OLF,with facet involved less than 50%,which should not impair thoracic stability.

关 键 词：黄韧带骨化症 经皮脊柱内镜术 精准减压 

分 类 号：R687[医药卫生—骨科学]