采用经椎间隙脊髓环形减压术治疗严重胸椎后纵韧带骨化症

发布时间：2018-10-19 14:37

【摘要】：目的:探讨采用后路经椎间隙脊髓环形减压术治疗严重胸椎后纵韧带骨化症安全有效的手术方法与疗效评价。方法:自2010年05月至2014年05月,15例合并有后纵韧带骨化(OPLL)、侵占率超过50%以上的胸椎管狭窄患者行后路环形减压,其中男性患者9例,女男性患者6例,年龄42-69岁,平均56.3岁。术前均有严重脊髓压迫症状。手术从后路正中入路,先于减压节段相邻的上下两个椎体,预置椎弓根螺钉道,然后采用“揭盖法”分别去除压迫节段椎管的后壁,完成脊髓背侧的减压。经上、下关节突关节处,切除关节,向外侧推开肋间神经,显露椎体外间隙及椎间盘组织,切除椎间盘,并凿除后纵韧带骨化下椎体松质骨。分离硬脊膜腹侧粘连,用特制工具切除后纵韧带上下边缘,压塌,取出后纵韧带骨化块,经一侧或两侧完成脊髓腹侧的减压。最后置入椎弓根钉,并行椎间植骨。术后随访(平均随访21.5月)行CT及MRI扫描,采用JOA评分及Frankel分级评价脊髓神经功能术前及术后情况,Otani评分系统行术后疗效评估并计算临床优良率,评价治疗效果。结果:14例患者术后即有明显脊髓神经功能改善,1例出现单侧下肢肌力一过性下降,3例术后脑脊液漏。术后随访无胸椎不稳,无内固定松动断裂。术中分离硬膜与骨化的后纵韧带粘连导致脑脊液漏3例。手术时间180min-300min,平均为240min;出血量150ml-270ml,平均出血量168ml。Frankel分级改善明显,术前的平均JOA评分3.5±0.98,至末次随访JOA评分提高至9.0±0.90,较术前明显改善(P0.05)。根据Otani评分标准,优9例,良5例,可1例,差0例;优良率为93.3%。结论:采用后路经椎间隙行脊髓环形减压治疗严重胸椎后纵韧带骨化,可在较小的显露范围内,使用自主研制特殊手术工具安全完成前方骨块切除,脊髓减压充分,术后疗效肯定。
[Abstract]:Objective: to evaluate the safety and efficacy of posterior decompression of spinal cord through intervertebral space in the treatment of severe ossification of the posterior longitudinal ligament of thoracic vertebrae. Methods: from May 2010 to May 2014, 15 cases of thoracic spinal canal stenosis with ossification of posterior longitudinal ligament (OPLL),) were treated with posterior loop decompression, including 9 male patients and 6 female patients, aged 42-69 years (mean 56.3 years). All patients had severe spinal cord compression before operation. The decompression of the dorsal spinal cord was accomplished by removing the posterior wall of the spinal canal by removing the posterior wall of the vertebral canal by the posterior approach, which was prior to the upper and lower vertebrae adjacent to the decompression segment and presetting the pedicle screw canal. The intercostal nerve was removed from the upper and inferior facet joints and the intercostal nerve was pushed open to reveal the outer space of the vertebral body and the intervertebral disc tissue. The intervertebral disc was removed and the cancellous bone of the vertebra body was cut off by ossification of the posterior longitudinal ligament. The ventral adhesion of the dura dural was separated, the upper and lower edges of the posterior longitudinal ligament were excised with special tools, the ossification of the posterior longitudinal ligament was removed, and the decompression of the ventral side of the spinal cord was completed through one or both sides. Finally, pedicle screw was inserted and intervertebral bone graft was performed. CT and MRI were followed up for an average of 21.5 months. JOA score and Frankel grading were used to evaluate the neurological function before and after operation, and the Otani score system was used to evaluate the postoperative curative effect, calculate the clinical excellent and good rate and evaluate the therapeutic effect. Results: 14 cases had obvious improvement of spinal cord nerve function, 1 case had temporary decline of lower extremity muscle strength, 3 cases had cerebrospinal fluid leakage. There was no instability of thoracic vertebra and no loose fracture of internal fixation. Intraoperative separation of dura and ossification of posterior longitudinal ligament resulted in cerebrospinal fluid leakage in 3 cases. The mean operation time was 180 min-300 min, the mean blood loss was 150ml-270 ml, the average 168ml.Frankel grade was improved obviously, the preoperative average JOA score was 3.5 卤0.98, and the last follow-up JOA score increased to 9.0 卤0.90, which was significantly improved than that before operation (P0.05). According to Otani score, 9 cases were excellent, 5 cases were good, 1 case was fair, 0 case was poor. Conclusion: the treatment of severe ossification of the posterior longitudinal ligament of thoracic vertebrae by circular decompression of spinal cord via posterior approach can safely complete anterior bone mass resection and decompression of spinal cord in a relatively small exposure area. The curative effect was positive after operation.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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