Delta大通道脊柱内镜技术治疗胸椎黄韧带骨化症疗效分析  

Analysis of the Therapeutic Effect of Large-Channel Spinal Endoscopy Technique in the Treatment of Thoracic Ligamentum Flavum Ossification

作　　者：窦荣声 张羽 于明东[2] 闫浩 朱昱山 魏汝硕 王炳武[2] Dou Rongsheng;Zhang Yu;Yu Mingdong;Yan Hao;Zhu Yushan;Wei Rushuo;Wang Bingwu(School of Clinical Medicine,Shandong Second Medical University,Weifang 261042,China;Department of Spine Surgery,Weifang People’s Hospital,Weifang 261044,China)

机构地区：[1]山东第二医科大学临床医学院,山东潍坊261042 [2]潍坊市人民医院脊柱外科,山东潍坊261044

出　　处：《实用骨科杂志》2024年第8期686-690,共5页Journal of Practical Orthopaedics

基　　金：中央高水平医院临床科研专项(2022-PUMCH-D-004);山东省自然科学基金项目(ZR2022MH273);潍坊市科技发展计划项目(2021YX098)。

摘　　要：目的探讨Delta大通道脊柱内镜下单侧入路双侧减压技术治疗胸椎黄韧带骨化症的临床疗效。方法回顾性分析2019年8月至2022年1月潍坊市人民医院采用Delta大通道脊柱内镜治疗的13例胸椎黄韧带骨化症患者,其中男6例,女7例;年龄55~69岁,平均(62.62±4.01)岁。记录患者基本信息及围手术期相关指标,并在术后1个月、6个月进行随访,记录术前术后改良日本骨科协会评分(modified Japanese orthopaedic association score,mJOA)、美国脊髓损伤协会(American spinal injury association,ASIA)感觉评分(ASIA sense score,ASS)和双下肢运动评分(ASIA motor score,AMS)变化情况。以mJOA评分计算术后6个月随访时的改善率(recover rate,RR)及优良率,对RR与性别、年龄、术前mJOA评分、影像学分型及病程进行相关性分析。结果平均手术时间为(108.46±16.12)min,平均出血量(23.46±7.47)mL,平均住院时间(6.08±0.86)d。术后随访时间为6~35个月,平均(16.77±9.33)个月,术后1个月及6个月随访时,mJOA、ASS、AMS评分均优于术前(P<0.05),平均RR为(55.69±19.73)%,优良率为69.23%。RR与术前病程呈负相关(P<0.001),与术前mJOA评分呈正相关(P=0.029),与性别、年龄、影像学分型均无明显相关性(P>0.05)。结论Delta大通道脊柱内镜技术治疗胸椎黄韧带骨化症安全可靠,具有术后恢复快、创伤小、出血量少等优势,短期效果良好。Objective To retrospectively analyzed the clinical efficacy of the treatment of thoracic ossification of ligamentum flavum with unilateral laninotomy and bilateral decompression under Delta canal endoscopy.Methods A retrospective analysis was conducted on 13 patients with thoracic ossification of the ligamentum flavum who underwent Delta canal endoscopy between August 2019 and January 2022 in Weifang People’s Hospital.6 males and 7 females,aged 55 to 69 years,with a mean age of(62.62±4.01)years.Patient demographics and perioperative parameters were recorded,and follow-up assessments were performed at 1 month and 6 months postoperatively to document changes in pre-operative and post-operative modified Japanese orthopaedic association score(mJOA),American spinal injury association sense score(ASS)and American spinal injury association motor score(AMS).The recovery rate and excellent rate based on mJOA scores at the 6-month follow-up were calculated,followed by correlation analyses between RR and gender,age,preoperative mJOA score,radiographic classification type,as well as disease duration.Results The mean operation time was(108.46±16.12)minutes,the average blood loss was(23.46±7.47)mL,and the mean length of hospital stay was(6.08±0.86)days.All patients completed the follow-up period,duration ranging from 6 to 35 months,averaging at(16.77±9.33)months.At 1-month and 6-month follow-up after surgery,mJOA,ASS,and AMS scores exhibited significant improvement compared to preoperative values(P<0.05).The mean recovery rate was(55.69±19.73)%with a good-to-excellent rate of 69.23%.Preoperative disease duration showed a negative correlation with the recovery rate(P<0.001),while preoperative mJOA score demonstrated a positive correlation with the recovery rate(P=0.029).No significant correlations were found between the recovery rate and gender,age or radiographic classification(P>0.05).Conclusion The utilization of transforaminal endoscopic technique for the management of TOLF is deemed to be a safe and dependable appr

关 键 词：脊柱内镜 单侧入路双侧减压 胸椎黄韧带骨化 并发症 

分 类 号：R687[医药卫生—骨科学]