Endo-ULBD治疗胸椎黄韧带骨化症的安全性与有效性研究  

The Safety and Efficacy of Endo-ULBD Technique in the Treatment of Thoracic Ossification of the Ligamentum Flavum

作　　者：木热提·卡哈尔 地力木拉提·艾克热木 张树文 徐阔[1] Mureti·Kahaer;DiliMulati·Aikeremu;Zhang Shuwen;Xu Kuo(Second Spine Ward,Orthopaedic Centre,Xinjiang Uygur Autonomous Region People’s Hospital,Urumqi 830000,China)

机构地区：[1]新疆维吾尔自治区人民医院骨科中心脊柱二病区,新疆乌鲁木齐830000

出　　处：《实用骨科杂志》2024年第8期691-695,700,共6页Journal of Practical Orthopaedics

摘　　要：目的评估经皮脊柱内镜单侧椎板切开双侧减压(percutaneous endoscopic unilateral laminectomy for bilateral decompression,Endo-ULBD)技术治疗胸椎黄韧带骨化症(thoracic ossification of ligamentum flavum,TOLF)的安全性与有效性。方法回顾性分析新疆维吾尔自治区人民医院2019年1月至2023年1月收治的28例TOLF患者,其中14例接受Endo-ULBD手术(Endo-ULBD组),其中男7例,女7例;年龄50~73岁,平均(61.79±8.33)岁。14例接受传统后路椎板切除或联合融合固定手术(开放组),其中男10例,女4例;年龄50~70岁;平均(60.57±6.10)岁。对比两组患者的一般基线资料以及手术时间、住院时间、术中出血量、术后疼痛视觉模拟评分(visual analogue scale,VAS)、日本骨科协会(Japanese orthopaedic association,JOA)评分、日常生活活动能力(activities of daily living,ADL)、Oswestry功能障碍指数(Oswestry disability index,ODI)及并发症情况。结果两组术中出血量及住院时间比较,差异有统计学意义(P<0.05),但手术时间上差异无统计学意义(P>0.05)。两组患者术后1、6个月以及末次随访中的VAS、JOA、ADL、ODI评分比较,差异无统计学意义(P>0.05),但两组组内各时间点比较,上述指标差异均有统计学意义(P<0.05)。Endo-ULBD组未出现脑脊液漏、硬膜外血肿、脊髓神经功能恶化、神经损伤或切口感染等并发症,而传统手术组有2例(14.2%)发生脑脊液漏,1例(7.1%)术后头痛、颈痛。结论Endo-ULBD是治疗TOLF的有效且安全的方法,适用于包括硬膜骨化在内的病例,且不影响胸椎稳定性。Objective To evaluate the safety and efficacy of percutaneous endoscopic unilateral laminectomy for bilateral decompression(Endo-ULBD)in the treatment of thoracic ossification of the ligamentum flavum(TOLF).Methods A retrospective analysis was conducted on 28 patients with TOLF admitted to the People’s Hospital of Xinjiang Uygur Autonomous Region from January 2019 to January 2023.Among them,14 patients underwent Endo-ULBD surgery,comprising 7 males and 7 females,with ages ranging from 50 to 73 years old and a mean age of(61.79±8.33)years.The remaining 14 patients received traditional posterior laminectomy or combined fusion and fixation surgery,including 10 males and 4 females,with ages spanning from 50 to 70 years old and a mean age of(60.57±6.10)years.Comparisons were made between the two patient groups regarding general baseline data,surgical duration,hospital stay,intraoperative blood loss,postoperative visual analogue scale(VAS)scores for pain,Japanese orthopaedic association(JOA)scores,activities of daily living(ADL)scores,Oswestry disability index(ODI)scores,and the incidence of complications.Results The comparison of intraoperative blood loss and hospital stay duration between the two groups revealed significant statistical differences(P<0.05),whereas the difference in operation time was not statistically significant(P>0.05).The VAS,JOA,ADL,and ODI scores of both groups at 1 month,6 months postoperatively,and at the final follow-up did not exhibit statistically significant differences(P>0.05).However,within each group,the comparison of these indicators across different time points showed statistical differences(P<0.05).In the Endo-ULBD group,there were no complications such as cerebrospinal fluid leakage,epidural hematoma,spinal nerve function deterioration,nerve damage,or incision infection.In contrast,the traditional surgery group reported 2 cases(14.2%)of cerebrospinal fluid leakage and 1 case(7.1%)of postoperative headache and neck pain.Conclusion Endo-ULBD is an effective and safe surgical method

关 键 词：胸椎黄韧带骨化症 微创手术 经皮内镜单侧椎板切除术 手术减压 

分 类 号：R687[医药卫生—骨科学]