超声骨刀系统行椎板切除、后纵韧带骨化块切断联合去后凸矫形治疗多节段胸椎后纵韧带骨化症  

Application of ultrasonic bone scalpel system for laminectomy and posterior longitudinal ligament ossification block release combined with dekyphosis orthopedic surgery in treatment of multisegmental thoracic ossification of posterior longitudinal ligament

作　　者：李玉伟[1] 严晓云[1] 潘传红[1] 崔巍[1] 王海蛟[1] LI Yuwei;YAN Xiaoyun;PAN Chuanhong;CUI Wei;WANG Haijiao(Department of Orthopedics,Luohe Central Hospital,Luohe Henan,462000,P.R.China)

机构地区：[1]漯河市中心医院脊柱科,河南漯河462000

出　　处：《中国修复重建外科杂志》2024年第9期1086-1091,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：河南省医学科技攻关项目(LHGJ2020230937)。

摘　　要：目的探讨采用超声骨刀系统行椎板切除、后纵韧带骨化块切断联合去后凸内固定矫形术治疗多节段胸椎后纵韧带骨化症(thoracic ossification of posterior longitudinal ligament,T-OPLL)的安全性及临床疗效。方法回顾分析2020年1月—2023年4月采用超声骨刀系统行椎板切除、后纵韧带骨化块切断联合去后凸内固定矫形术治疗的8例多节段T-OPLL患者临床资料。男3例,女5例;年龄41~67岁,平均57.1岁。病程3~74个月,平均33.4个月。主要临床症状为进行性双下肢麻木无力、行走不稳,有胸背部疼痛者3例,大小便功能障碍者5例;7例表现为下肢肌张力增高、腱反射亢进、Babinski征阳性,1例为下肢肌力减弱、皮肤感觉减退、腱反射减弱、病理征阴性。8例均存在多节段胸椎后纵韧带骨化,骨化节段4~8节;5例合并多节段黄韧带骨化。术前日本骨科协会(JOA)胸脊髓功能评分为(4.3±0.9)分,疼痛视觉模拟评分(VAS)为(6.9±1.0)分,胸椎管狭窄节段后凸Cobb角为(34.62±10.76)°。记录手术时间、术中出血量及并发症发生情况。采用VAS评分评估患者腰背部疼痛,JOA评分评价胸脊髓功能并计算JOA改善率,测量狭窄节段后凸Cobb角并计算后凸Cobb角改善率。结果手术时间210~340 min,平均271.62 min;术中出血量900~2100 mL,平均1458.75 mL。切除椎板数4~8节,平均6.1节。3例术中出现硬膜撕裂及脑脊液漏,患者切口均Ⅰ期愈合。8例患者均获随访,随访时间12~26个月,平均18.3个月。无内固定物松动、断钉、断棒等并发症发生,骨化块未见明显进展。末次随访时,VAS评分为(1.4±0.7)分,JOA胸脊髓功能评分为(9.8±0.7)分,狭窄节段后凸Cobb角为(22.12±8.28)°,均较术前显著改善(t=11.887,P<0.001;t=13.015,P<0.001;t=7.395,P<0.001)。JOA改善率为81.06%±10.93%,其中优5例、良3例;后凸Cobb角改善率为36.51%±14.20%。结论采用超声骨刀系统行椎板切除、后纵韧带骨化块切断联合去�Objective To explore the safety and effectiveness of multisegmental thoracic ossification of posterior longitudinal ligament(T-OPLL)treated by laminectomy,posterior longitudinal ligament ossification block release combined with dekyphosis orthopedic surgery using ultrasonic bone scalpel system.Methods The clinical data of 8 patients with multisegmental T-OPLL treated with laminectomy,posterior longitudinal ligament ossification block release combined with dekyphosis orthopedic surgery using ultrasonic bone scalpel system between January 2020 and April 2023 was retrospectively analyzed.There were 3 males and 5 females;the age ranged from 41 to 67 years,with a mean of 57.1 years.The disease duration ranged from 3 to 74 months,with a mean of 33.4 months.Symptoms were progressive numbness and weakness of both lower limbs,unsteady walking,chest and back pain in 3 cases,and urinary and bowel dysfunction in 5 cases;7 cases showed increased muscle strength of the lower limbs,hyperreflexia of the tendons,and a positive Babinski sign,and 1 case showed decreased muscle strength of the lower limbs,decreased skin sensation,decreased knee and Achilles tendon reflexes,and a negative pathologic sign.Multisegmental posterior longitudinal ligament ossification of thoracic spine was found in 8 cases,with 4-8 segments of ossification,and in 5 cases with multisegmental ossification of the ligamentum flavum.The preoperative Japanese Orthopaedic Association(JOA)thoracic spinal function score was 4.3±0.9,the visual analogue scale(VAS)score was 6.9±1.0,and the the kyphotic Cobb angle of the stenosis segment was(34.62±10.76)°.The operation time,intraoperative blood loss,and complications were recorded.VAS score was used to evaluate the back pain,JOA score was used to evaluate the thoracic spinal cord function and the JOA improvement rate was calculated,and the kyphotic Cobb angle of the stenosis segment was measured and the Cobb angle improvement rate was calculated.Results The operation time ranged from 210 to 340 minutes,with a mean

关 键 词：胸椎后纵韧带骨化症 椎管狭窄 超声骨刀 

分 类 号：R687.3[医药卫生—骨科学]