基于硬膜骨化风险的分级减压手术策略在胸椎黄韧带骨化中的应用  

Application of graded decompression surgical strategy based on the risk of dural ossification for thoracic ossification of the ligamentum flavum

作　　者：李春旭 柏秋实 翟吉良[1] 赵宇[1,2,3] LI Chunxu;BAI Qiushi;ZHAI Jiliang;ZHAO Yu(Department of Orthopaedics,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;Translational Medical Center,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100035,China;National Key Laboratory for the Study of Common Mechanisms of Major Diseases,Institute of Basic Medical Sciences,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100005,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院骨科,北京100730 [2]中国医学科学院北京协和医学院北京协和医院转化医学中心,北京100035 [3]中国医学科学院北京协和医学院基础医学研究所重大疾病共性机制研究全国重点实验室,北京100005

出　　处：《中华骨与关节外科杂志》2024年第8期686-692,共7页Chinese Journal of Bone and Joint Surgery

基　　金：国家自然科学基金(82072508);北京协和医院临床医学博士后科研孵育基金(kyfyjj202302)。

摘　　要：目的:评价基于硬膜骨化(DO)风险的分级减压手术策略治疗胸椎黄韧带骨化(TOLF)的手术效果。方法:回顾性分析2017年1月至2023年2月北京协和医院收治的根据分级减压手术策略治疗的51例TOLF患者的临床资料。术前根据患者DO风险分为DO低危组和DO高危组。记录患者年龄、性别、体重指数(BMI)、临床症状及体征、手术节段数、术中出血量、术后引流时间及术后是否发生脑脊液漏(CSFL)。同时,采用日本骨科学会(JOA)评分及术后神经功能改善率(RR)对患者神经功能进行评估。结果:本组51例患者中,DO低危组38例,DO高危组13例。DO低危组患者下肢疼痛占比高于DO高危组患者[39.5%(15/38)vs.7.7%(1/13)],且差异有统计学意义(P<0.05)。两组患者年龄、性别、BMI、手术前后JOA评分、术后神经功能RR差异均无统计学意义(P均>0.05)。DO高危组患者手术节段数、术中出血量均多于DO低危组患者,术后引流时间长于DO低危组患者,且差异均有统计学意义(P均<0.05),DO高危组患者CSFL发生率高于DO低危组患者,且差异有统计学差异(P<0.001)。结论:基于DO风险治疗TOLF患者的新手术策略具有降低TOLF患者术后CSFL发生率和减少DO对神经功能恢复不良影响的优势。Objective:To investigate the efficacy of graded decompression surgical strategy based on the risk of dural ossification(DO)in the treatment of thoracic ossification of the ligamentum flavum(TOLF).Methods:The clinical data of 51 TOLF patients treated with graded decompression surgical strategy at Peking Union Medical College Hospital from January 2017 to February 2023 were retrospectively analyzed.Patients were preoperatively divided into low-risk and high-risk groups based on DO risk.Age,gender,body mass index(BMI),clinical symptoms,signs,surgical segments,intraoperative blood loss,postoperative drainage time,and postoperative cerebrospinal fluid leakage(CSFL)were collected in the two groups.Additionally,the preoperative and postoperative neurological function of the patients was evaluated using the Japanese Orthopedic Association(JOA)score and the recovery rate(RR).Results:Among the 51 patients,38 were in the low-risk group,and 13 were in the high-risk group.The proportion of patients with lower limb pain was significantly higher in the low-risk group than in the high-risk group(39.5%[15/38]vs.7.7%[1/13])(P<0.05).There was no significant difference between the two groups in age,gender,BMI,preoperative or postoperative JOA score,or RR(all P>0.05).The number of surgical segments and intraoperative blood loss were greater in the high-risk group than in the low-risk group,and the postoperative drainage time was significantly longer in the high-risk group than in the low-risk group(P<0.05).In addition,the incidence of CSFL in the high-risk group was significantly higher than that in the low-risk group(P<0.001).Conclusions:This study proposes a new surgical strategy for treating TOLF patients based on DO risk,which has the advantages of reducing the incidence of postoperative CSFL in TOLF patients and reducing the adverse effects of DO on neurological recovery.

关 键 词：胸椎黄韧带骨化 硬膜骨化 分级减压 脑脊液漏 神经功能 

分 类 号：R681.5[医药卫生—骨科学]