椎体后纵韧带骨化物复合体前移治疗重度胸椎管狭窄症  

Controllable thoracic column antedisplacement and fixation for serious thoracic spinal stenosis

作　　者：易红蕾 陈虎 陈兴捷[1,2] 王昕辉 章凯 YI Hong-lei;CHEN Hu;CHEN Xing-jie;WANG Xin-hui;ZHANG Kai(General Hospital of PLA Southern Theater;Postgraduate Institute,Southern Medical University,Guangzhou 510000,China)

机构地区：[1]中国人民解放军南部战区总医院 [2]南方医科大学研究生院,广州510000

出　　处：《中国矫形外科杂志》2020年第15期1422-1425,共4页Orthopedic Journal of China

基　　金：广州市珠江科技新星人才项目(编号:201610010135);广州市科技计划项目(201904010349);军队医学科技青年培育计划孵化项目(编号:19QNP040)。

摘　　要：[目的]介绍胸椎椎体及后纵韧带骨化物复合体前移术治疗重度胸椎管狭窄症的技术及体会。[方法]对1例重度胸椎OPLL并胸椎管狭窄症患者实施此手术。行后正中切口,前移段及上下各2节段置入双侧椎弓钉,前移段钉尾较固定段高出8 mm,切除前移段椎板及肋骨头,松解前移段上、下椎间盘,并切除关节突。将棒置入螺钉U形槽,先锁紧前移段,再逐步向前压棒,锁紧上下固定段螺母,将前移段椎体及骨化物复合体向前推移。[结果]术程顺利,术中均未出现血气胸、脊髓损伤或脑脊液漏等并发症。手术时间6 h,术中出血量约800 ml。术后患者下肢麻木、乏力症状明显缓解,JOA评分由5分提高到9分。CT可见椎管最狭窄的地方由术前的3.2 mm扩大为术后11.2 mm。[结论]胸椎椎体及后纵韧带骨化物复合体前移固定术是治疗重度胸椎后纵韧带骨化症致胸椎管狭窄的一种新的安全有效的术式,但是需要进一步探究手术的相关适应证及手术技术。[Objective]To introduce the surgical technique and primary clinical outcomes of controllable thoracic column antedisplacement and fixation(TCAF)for serious thoracic spinal stenosis.[Method]A patient underwent this surgical procedure for ossification of posterior longitudinal ligament(OPLL)accompanied with serious thoracic spinal stenosis.A posterior midline incision was made,and then bilateral pedicle screws were placed on the shifting segments and 2 segments upper and lower adjacency with the screw ends on the shifting segmental 8 mm posterior to those on the anchoring segments.After laminectomy and resection of rib heads were conducted on the shifting segments,as well as intervertebral disc release and bilateral facetectomy were done on the shifting-anchoring junction,a pair rods was placed on the U-shaped slots of the screw end to push the shifting segments anterior gradually.[Result]The operation was performed successfully with operation time of 6 hours and blood loss of 800 ml,without any complications,such as blood pneumothorax,spinal cord injury or dura tear.The patient got significant symptom relief after operation,including numbness and weakness of lower limbs,associated with significant improvement of JOA score from 5 preoperatively to 9 postoperatively.Regarding imaging assessment,the narrowest distance from the maximal OPLL to the posterior wall considerably increased from 3.2 mm preoperatively to 11.2 mm postoperatively,associated with remarkable decompression of the spinal cord.[Conclusion]TCAF is effective and safe for decompression of thoracic spinal stenosis secondary to OPLL.However,further studies are warranted to investigate more details of TCAF.

关 键 词：胸椎椎管狭窄 后纵韧带钙化 椎体前移固定 脊髓减压 

分 类 号：R681.57[医药卫生—骨科学]