孤岛漂浮揭盖术治疗黄韧带骨化所致胸椎管狭窄及脊髓病的近期疗效  

Short-term effectiveness of floating island laminectomy surgery for thoracic spinal stenosis and myelopathy caused by ossification of ligamentum flavum

作　　者：钟诚 修鹏[1] 陈华[1] 李涛[1] ZHONG Cheng;XIU Peng;CHEN Hua;LI Tao(Department of Orthopedics,West China Hospital,Sichuan University,Chengdu Sichuan,610041,P.R.China)

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中国修复重建外科杂志》2025年第4期466-469,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨孤岛漂浮揭盖术治疗黄韧带骨化所致胸椎管狭窄及脊髓病的近期疗效。方法2019年1月—2022年4月,采用孤岛漂浮揭盖术治疗31例黄韧带骨化所致胸椎管狭窄及脊髓病患者。男17例,女14例;年龄36~78岁,平均55.9岁。脊髓压迫症状持续时间3~62个月,平均27.2个月。病变累及节段T1~64例,T7~1227例。术前神经功能采用改良日本骨科协会(m JOA)评分为(4.7±0.6)分。记录手术时间、术中出血量和并发症发生情况;术后行胸椎MRI复查评估脊髓压迫和减压程度,采用m JOA评分评价患者神经功能并计算术后12个月恢复率。结果手术时间122~325 min,平均204.5 min;术中出血量150~800 m L,平均404.8 m L。术后切口均Ⅰ期愈合。患者均获随访,随访时间12~14个月,平均12.5个月。患者下肢无力、步态障碍、疼痛等症状均明显改善。术后各时间点m JOA评分均较术前提高(P<0.05),且随时间延长,评分进一步改善,其中1、3、6个月间差异有统计学意义(P<0.05)。术后12个月恢复率为69.76%±11.38%,其中神经功能达优10例、良21例。术中发生硬脊膜撕裂3例、硬脊膜缺损1例;术后发生脑脊液漏2例;无神经损伤加重、黄韧带骨化复发或术后胸椎畸形发生。结论孤岛漂浮揭盖术治疗黄韧带骨化所致胸椎管狭窄及脊髓病安全,可有效避免神经系统症状加重,早期神经功能改善和功能恢复较好。Objective To explore short-term effectiveness of floating island laminectomy surgery in treating thoracic spinal stenosis and myelopathy caused by ossification of the ligamentum flavum.Methods A total of 31 patients with thoracic spinal stenosis and myelopathy caused by ossification of the ligamentum flavum between January 2019 and April 2022 were managed with floating island laminectomy surgery.The patients comprised 17 males and 14 females,aged between 36 and 78 years,with an average of 55.9 years.The duration of symptoms of spinal cord compression ranged from 3 to 62 months(mean,27.2 months).The lesions affected T1-6 in 4 cases and T7-12 in 27 cases.The preoperative neurological function score from the modified Japanese Orthopaedic Association(mJOA)was 4.7±0.6.Surgical duration,intraoperative blood loss,and complications were recorded.The thoracic MRI was conducted to reassess the degree of spinal cord compression and decompression after operation.The mJOA score was employed to evaluate the neurological function and calculate the recovery rate at 12 months after operation.Results The surgical duration ranged from 122 to 325 minutes,with an average of 204.5 minutes.The intraoperative blood loss ranged from 150 to 800 mL(mean,404.8 mL).All incisions healed by first intention after operation.All patients were followed up 12-14 months,with an average of 12.5 months.The patients’symptoms,including lower limb weakness,gait disorders,and pain,significantly improved.The mJOA scores after operation significantly increased when compared with preoperative scores(P<0.05),gradually improving with time,with significant differences observed among 1,3,and 6 months(P<0.05).The recovery rate at 12 months was 69.76%±11.38%,with 10 cases exhibiting excellent neurological function and 21 cases showing good.During the procedure,there were 3 cases of dural tear and 1 case of dural defect.Postoperatively,there were 2 cases of cerebrospinal fluid leakage.No aggravated nerve damage,recurrence of ligamentum flavum ossification,or po

关 键 词：孤岛漂浮揭盖术 黄韧带骨化 胸椎管狭窄 胸椎脊髓病 

分 类 号：R687.3[医药卫生—骨科学]