经根黄通道八边形游离整块切除胸椎上关节突及骨化黄韧带

En bloc resection of the superior facet process and ossified ligamentum flavum of thoracic spine via pedicel- ligament flavum octagonal tunnel

中文关键词:  胸椎  黄韧带  骨化  根黄通道  治疗

英文关键词:Thoracic vertebra  Ligamentum flavum  Ossification  Pedicle flavum tunnel  Treatment

中文摘要:

  【摘要】 目的：探讨经根黄通道应用八边形游离整块切除胸椎上关节突及骨化黄韧带法治疗胸椎黄韧带骨化合并脊髓病的疗效。方法：2002年1月～2007年1月共收治胸椎黄韧带骨化合并脊髓病患者90例，男58例，女32例；年龄32～79岁，平均54.2岁。患者术前主要存在感觉障碍和下肢疼痛、麻木83例，束带感69例，括约肌功能障碍53例。以CT仿真内窥镜及三维同步定位像观察椎管内的骨化黄韧带及其毗邻关系结构。采用经根黄通道八边形游离整块切除胸椎上关节突及骨化黄韧带。用JOA括约肌功能评分和下肢运动功能评分以及运动功能恢复率评估疗效。结果：CT三维重建下，90例患者均见根黄通道的存在。手术均取得成功，手术时间2.7±0.8h，出血量260±120ml。85例术后症状立即缓解，无术后加重期。5例发生脑脊液漏，经对症处理后痊愈。病例随访13～38个月，平均23.2个月。83例感觉障碍及下肢麻木疼痛者完全恢复66例，部分恢复17例。69例束带感者恢复67例。术后括约肌功能JOA评分为2.55±0.34分，与术前（2.27±0.54分）比较差异有显著性（P<0.01）；术后运动JOA评分为3.68±0.43分，与术前（1.53±0.86分）比较差异有显著性（P<0.01），恢复率平均为86.48%。疗效优良率为95.56%。结论：经根黄通道八边形游离整块切除胸椎上关节突及骨化黄韧带减压充分、相对安全和简便。

英文摘要:

  【Abstract】 Objective：To investigate the efficacy of en bloc resection of the superior facet process and ossified ligamentum flavum of thoracic spine via pedicel-flavum tunnel（PFT）.Method：90 patients from January 2002 to January 2007 diagnosed as thoracic ossification of ligamentum flavum were reviewed retrospectively，there were 58 males and 32 females with an average age of 54.2 years（range，32-79 years）.83 cases presented with sensory deficit of lower limbs，69 cases with constriction on trunk or lower limbs，53 cases with sphincter dysfunction.The CT virtual endoscopy（CTVE） and multiplanar co-localization were used to detect the configuration of OLF and its adjacent morphology.All patients underwent the surgical protocol of removing thoracic superior facet process and OLF through pedicle flavum tunnel（PFT）.The IMSOP Standard Neurological Classification of Spinal Cord Injury was used to determine the level of thoracic spondylopathy.The JOA for lower limb motor function and sphincter function were used to evaluate their neurological status respectively.Result：PFT was evidenced in all the patients on 3-dimensional CT reconstruction.All cases were successfully operated，85 cases had symptom relieved immediately after operation，5 cases were complicated with cerebrospinal fluid leakage.The operative time was 2.7±0.8hr and the amount of blood loss was 260±120ml.The mean follow up was 23.2 months（range，13-38 months）.Among 83 with sensory deficit，66 recovered completely and the other 17 got partial recovery，67 cases with trunk or lower limbs constriction recovered completely.Postoperative JOA score for sphincter function was 2.55±0.34，comparing with preoperative score of 2.27±0.54，which showed significant difference（P<0.01）.Postoperative JOA score for motor function was 3.68±0.43，comparing with preoperative score of 1.53±0.86，which also showed significant difference（P<0.01）.The motor function recovery rate was 86.48%，with the excellent and good rate of 95.56%.Conclusion：En bloc resection of the superior facet process and ossified ligamentum flavum of thoracic spine via pedicle-flavum octagonal tunnel is safe and reliable.