全内镜下胸椎管减压术治疗胸椎管狭窄症的技术要点及疗效分析  

Full-endoscopic thoracic spinal decompression in the treatment of thoracic spinal stenosis: technical key points and clinical outcomes

作　　者：李文毅[1] 高尚聚[1] 曹参[1] 魏景超[1] 李萌 LI Wen-yi;GAO Shang-ju;CAO Can;WEI Jing-chao;LI Meng(Department of Orthopedics,Hebei General Hospital,Shijiazhuang,Hebei,050051,China)

机构地区：[1]河北省人民医院骨科,石家庄050051

出　　处：《中国骨与关节杂志》2022年第6期413-421,共9页Chinese Journal of Bone and Joint

基　　金：河北省医学科学研究重点课题计划项目(20180004)。

摘　　要：目的 总结全内镜下胸椎管减压术治疗胸椎管狭窄症的技术要点,分析全内镜下胸椎管减压术的临床疗效。方法 回顾性分析本院 2017 年 6 月至 2020 年 12 月收治的 27 例应用全内镜下椎管减压术治疗的单节段胸椎管狭窄症患者,致压因素为胸椎黄韧带骨化 (ossification of ligamentum flavum,OLF) 14 例,胸椎间盘突出伴纤维环骨化 2 例,后纵韧带骨化或椎体后缘骨赘 9 例,胸椎 OLF 合并后纵韧带骨化 2 例。根据致压因素位于脊髓腹侧或背侧压迫的严重程度,采取经椎板间入路或者经椎间孔入路。通过评价术前、术后和随访过程中的影像学表现评估手术减压情况。记录手术时间、手术并发症。应用改良日本骨科协会评分 (modified Japanese Orthopedic Association,mJOA,11 分法) 评估术前和术后的神经功能并计算其改善率。结果 所有手术顺利完成,采用经椎板间入路脊髓背侧减压术 14 例,经椎间孔入路脊髓腹侧减压术 11 例,经椎间孔入路脊髓腹侧背侧同时减压 2 例。手术时间为 159.1 min,其中经椎板间入路脊髓背侧减压手术时间为 160 min,经椎间孔入路脊髓腹侧减压手术时间为 136 min。所有患者术后及随访过程中的 CT 及 MRI 影像显示脊髓减压充分。术前 mJOA 评分 1~10 分,平均 (6.0±2.3) 分。末次随访时 mJOA 评分 5~11 分,平均 (8.7±2.0) 分,术前与术后差异有统计学意义 (P < 0.001),mJOA 评分改善率 25%~100%,平均 64.5%。术中并发颈项疼痛 2 例,术中一过性神经功能恶化 1 例。术中硬膜缺损 5 例,其中 4 例为胸椎 OLF 合并硬膜骨化,未行硬膜修补,术后未出现影像学或有临床表现的假性硬膜囊肿或切口不愈合。术后 48 h 出现迟发性硬膜外血肿 1 例,二次内镜下探查血肿清除术后症状改善。结论 全内镜下胸椎管减压术治疗胸椎管狭窄症是一项安全有效的技术,做到脊髓充分减压的同时可以更好地减小手术�Objective To summarize and introduce the technique of full-endoscopic thoracic spinal decompression in the treatment of thoracic spinal stenosis,and analyze the clinical effect of full-endoscopic thoracic spinal decompression surgery.Methods In our retrospective research between June 2017 and December 2020,27 patients with single segmental thoracic spinal stenosis received full-endoscopic decompression in our hospital.According to the pathogenic factors,there were 14 cases of thoracic ossification of ligamentum flavum (OLF),2 cases of disc herniation with calcified fibrous annulus,9 cases of ossification of the posterior longitudinal ligament or osteophyte,and 2 cases of multiple factors.The choice of interlaminar or transforaminal technique for surgical decompression depended on whether the pathogenic factor was located on the ventral or dorsal side of the spinal cord.The outcomes were evaluated by the postoperative and follow-up images.In addition,the operation time and complications were recorded.The results of the modified Japanese Orthopedic Association (mJOA,11 points) before operation and during the follow-up were compared to evaluate the improvement of neurological function before and after surgery.The improvement rate was also calculated.Results The surgeries were successfully completed for all the 27 patients,including 14 cases of full-endoscopic decompression via interlaminar approach,11 cases of transforaminal decompression,and 2 cases of transforaminal both ventral and dorsal decompression.The operation time of decompression via interlaminar approach was 160 minutes;the operation time of transforaminal ventral decompression was 136 minutes;the operation time of transforaminal both ventral and dorsal decompression was 159.1 minutes.All patients were sufficiently decompressed on CT and MRI after operation and during the follow-up.The mJOA was improved from 1-10 (average:6.0±2.3) before operation to 5-11 (average:8.7±2.0) at the last follow-up with statistical significance (P < 0.001).The improvement

关 键 词：胸椎 减压术 外科 椎管狭窄 最小侵入性外科手术 

分 类 号：R687.3[医药卫生—骨科学]