单侧双通道内镜技术治疗胸椎黄韧带骨化症  

Unilateral biportal endoscopic decompression for thoracic ossification of the ligamentum flavum

作　　者：赵加庆 于先凯 赵子豪 付国勇[1] 李雪城 任佳彬[1] 李瑞[1] 胡鹏[1] 朱锴[1] 耿晓鹏[1] ZHAO Jia-qing;YU Xian-kai;ZHAO Zi-hao;FU Guo-yong;LI Xue-cheng;REN Jia-bin;LI Rui;HU Peng;ZHU Kai;GENG Xiao-peng(The Affiliated Hospital,Binzhou Medical College,Binzhou 256603,China;Central Hospital of Shengli Oilfield,Dongying 257034,China)

机构地区：[1]滨州医学院附属医院,山东滨州256603 [2]胜利油田中心医院,山东东营257034

出　　处：《中国矫形外科杂志》2023年第7期619-624,共6页Orthopedic Journal of China

基　　金：山东省自然科学基金资助项目(编号:ZR2017LH020);山东省医药卫生科技计划(编号:2013WS0300)。

摘　　要：[目的]探讨单侧双通道内镜技术(unilateral biportal endoscopic,UBE)治疗胸椎黄韧带骨化症(thoracic ossification of ligament flavum,TOLF)的疗效及可行性。[方法]回顾性分析2018年1月—2021年5月本科收治的29例TOLF患者的临床资料,依据医患沟通结果,12例行UBE治疗(UBE组),17例行传统全椎板切除术治疗(开放组),比较两组围手术期、随访及影像结果。[结果]所有患者均顺利完成手术且无严重并发症发生。UBE组切口总长度、下地行走时间、住院时间均显著优于开放组(P<0.05),但术中透视次数显著多于开放组(P<0.05)。两组手术时间、切口愈合等级的差异均无统计学意义(P>0.05)。随访时间平均(14.0±1.3)个月,UBE组恢复完全负重活动时间显著早于开放组(P<0.05)。术后随时间推移,两组的ODI评分、JOA评分、锥体束征情况均显著改善(P<0.05),相应时间点,两组上述指标的差异均无统计学意义(P>0.05)。影像方面,两组术后胸椎后凸角、椎管面积、椎管矢状径均显著增大(P<0.05)。术前两组间上述影像指标的差异均无统计学意义(P>0.05),术后1个月及末次随访时,UBE组的胸椎后凸角和术后后侧骨丢失均显著小于开放组(P<0.05)。[结论] UBE及传统全椎板切除术均可有效治疗TOLF,相比之下,UBE创伤更小、对骨结构及稳定性破坏更少,术后恢复更快,并可减少术后胸椎后凸。[Objective] To explore the efficacy and feasibility of the unilateral biportal endoscopic(UBE) decompression for thoracic ossification of ligament flavum(TOLF).[Methods] A retrospective study was performed on 29 patients who receiced surgical decompression for TOLF in our hospital from January 2018 to May 2021.Bases on preoperative doctor-patient communication,12 patients underwent UBE,while the rmaining 17 patients were treated with the traditional open laminectomy.The documents regarding perioperative period,follow-up and radiographs were compared between the two groups.[Results] All patients in both groups had corresponding surgical procedures performed successfully without serious complications.The UBE group proved significantly superior to the open group in terms of total incision length,postoperative walking time and hospital stay(P<0.05),regardless of that the former took significantly more intraoperative fluoroscopy than the latter(P<0.05).However,there were no significant differences in terms of operation time and incision healing grade.All patinets in both group were followed up for(14.0±1.3) months on a mean,and the patients in the UBE group resumed full weight-bearing activity significantly earlier than those in the open group(P<0.05).The ODI and JOA scores,as well as pyramidal tract sign significantly improved over time in both groups(P<0.05),whereas which were not statistically significant between the two groups at any matching time points(P>0.05).Radiographically,the thoracic kyphosis angle,the spinal canal area and the sagittal diameter of the spinal canal were significantly increased in both groups after operation(P<0.05).Althogh no significant differences in aforesaid imaging data were found between the two groups preoperatively(P>0.05),the UBE group had significantly less thoracic kyphosis angle and posterior bone loss than the open group postoperatively(P<0.05),regardless of no significant differences in spinal canal area and canal sagittal diameter between them postoperatively(P>0.05).[Concl

关 键 词：胸椎黄韧带骨化症 胸椎椎管狭窄症 单侧双通道内镜技术 全椎板切除术 

分 类 号：R687[医药卫生—骨科学]