胸椎后路椎体－后纵韧带骨化物复合体可控前移治疗多节段连续型胸椎后纵韧带骨化症疗效观察

Clinical observation of posterior controllable antedisplacement, fixation and decompression of thoracic vertebrae-ossification of posterior longitudinal ligament complex in the treatment of multilevel continuous ossification of posterior longitudinal ligament of thoracic vertebrae

中文关键词:  胸椎  后纵韧带骨化  椎体-后纵韧带骨化物复合体  前移  疗效

英文关键词:Thoracic vertebra  Ossification of the posterior longitudinal ligament  Vertebrae-OPLL complex  Antedisplacement  Curative effect

中文摘要:

  【摘要】 目的：探讨胸椎后路椎体－后纵韧带骨化物复合体可控前移固定减压技术治疗多节段连续型胸椎后纵韧带骨化症（thoracic ossification of posterior longitudinal ligament，T-OPLL）的临床疗效。方法：回顾分析2018年5月～2020年6月于我院脊柱外科接受胸椎后路椎体-后纵韧带骨化物复合体可控前移固定减压技术治疗的22例多节段连续型T-OPLL患者，记录手术一般情况，统计患者发病节段、临床表现及并发症情况，并根据术前、术后的疼痛视觉模拟评分（visual analogue scale，VAS）、日本骨科协会（Japanese Orthopaedic Association，JOA）评分、Frankel分级、CT、MRI检查评估手术效果。结果：随访时间13～17（14.95±1.33）个月；手术时间200～310min（238.19±34.73min），出血量900～1800ml（1345.45±230.38ml）；患者术前、术后3个月、12个月、末次随访时VAS评分分别为7.59±0.73分、3.50±0.51分、2.41±0.50分、1.55±0.51分；术前和术后3个月、12个月、末次随访时的VAS评分差异有统计学意义（P<0.05）。患者术前、术后3个月、12个月、末次随访时JOA评分分别为4.64±1.84分、5.73±1.78分、6.82±1.33分、9.23±0.81分；术前和术后3个月、12个月、末次随访时的JOA评分差异具有统计学意义（P<0.05），末次随访时JOA评分改善率平均为（73.64±12.57）%。末次随访时患者Frankel分级改善1～3级（术前14例B级、4例C级、4例D级均恢复至E级）。末次随访时无内固定松动、断钉断棒等并发症，骨化物未见明显进展。结论：胸椎后路椎体－骨化物复合体可控前移固定减压技术能够借助钉棒固定系统将骨化物前移，实现对脊髓的原位减压，是一种安全有效的新术式，为胸椎后纵韧带骨化症的治疗提供了新思路。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical efficacy of posterior antedisplacement, fixation and decompression technique in the treatment of multi-segment continuous thoracic ossification of posterior longitudinal ligament(T-OPLL). Methods: From May 2018 to June 2020, 22 patients with multi-segment continuous T-OPLL who received this technique in the Spinal Surgery Department of Shanghai Changzheng Hospital were retrospectively analyzed. Preoperative and postoperative visual analogue scale(VAS) of pain, Japanese Orthopaedic Association (JOA) score, Frankel grading, CT and MRI were recorded to evaluate the surgical effect. At the same time, the general conditions of the operation was recorded, and the diseased segments, clinical manifestations, postoperative complications were counted. Results: The follow-up period was 13-17(14.95±1.33) months. The operative time was 200-310min(238.19±34.73min), and the blood loss was 900-1800ml(1345.45±230.38ml). VAS scores were 7.59±0.73 points, 3.50±0.51 points, 2.41±0.50 points, and 1.55±0.51 points before surgery, 3 months after surgery, 12 months after surgery, and at final follow-up, respectively. There were significant differences in VAS scores between preoperative and postoperative 3 months, 12 months and final follow-up(P<0.05). The JOA scores were 4.64±1.84 points, 5.73±1.78 points, 6.82±1.33 points, and 9.23±0.81 points before surgery, 3 months after surgery, 12 months after surgery, and at final follow-up, respectively. There were statistically significant differences between preoperative and postoperative JOA scores at 3 months, 12 months and at final follow-up(P<0.05), and the average improvement rate of JOA score at the final follow-up was (73.64±12.57)%. The Frankel classification of all patients showed 1-3 grade improvement(14 cases of grade B, 4 cases of grade C, and 4 cases of grade D preoperatively recovered to grade E), and there were no complications such as loosening of internal fixation, broken screw and broken rod during postoperative follow-up visit. Conclusions: Posterior controllable antedisplacement, fixation and decompression of thoracic vertebrae-ossification of posterior longitudinal ligament complex can controllably move the vertebral ossification complex to the ventral side with the help of screw and rod fixation system, and achieve in situ decompression of the spinal cord without the removal of the ossification. It is a safe and effective new surgical method which provides a new idea for the treatment of posterior longitudinal ligament ossification of the thoracic spine.