内镜下“沉船”减压技术治疗胸椎后纵韧带骨化症——基于尸体标本的技术报道

Endoscopic decompression of "sink boat" technique for the treatment of ossification of posterior longitudinal ligament(OPLL) in thoracic spine: a cadaver study

中文关键词:  经皮内镜技术  沉船减压技术  胸椎OPLL  尸体研究

英文关键词:Endoscopic spinal surgery  Sink boat technique  Thoracic OPLL  Cadaver study

中文摘要:

  【摘要】 目的：建立尸体标本的胸椎后纵韧带骨化（ossification of posterior longitudinal ligament，OPLL）模型，探究在模型上进行内镜下OPLL“沉船”减压技术（sink boat technique，SBT）的可行性。方法：采用新鲜冰冻尸体标本，在导航机器人定位和CT引导下，从侧方经胸腔按术前规划路径穿刺T9椎体后缘。穿刺到达椎体后缘中份后，推注骨水泥并使之沿后纵韧带渗透到椎管内，CT扫描确认骨水泥渗入椎管并分布在T9椎体后方即认为模拟OPLL制备成功。采用内镜下SBT，从一侧椎间孔和对侧部分椎弓根入路进入椎体，从两侧向中心磨除部分椎体，直至双侧贯通，形成凹槽状椎体后缘的缺损，能够容纳模拟的OPLL。使用带线锚钉，将OPLL骨块锚定下沉并固定在椎体凹槽内，以达到椎管腹侧减压的目的。结果：我们成功在尸体标本上制备了胸椎OPLL的骨水泥模型，T9椎体后缘模拟OPLL椎管侵占率达49%。内镜下SBT手术顺利完成了胸脊髓腹侧的减压，术后CT证实模拟的OPLL通过内镜下SBT技术成功沉入并固定在椎体内，椎管矢状径恢复率达218%。结论：内镜下SBT是一种创新的胸椎内镜手术方法，在尸体上可以将模拟的节段性胸椎OPLL沉入椎体内达到椎管减压的目的。

英文摘要:

  【Abstract】 Objectives: To establish a cadaveric model of ossification of posterior longitudinal ligament(OPLL) in thoracic spine and explore the feasibility of performing the endoscopic sink boat technique(SBT) for OPLL decompression on the cadaveric model. Methods: A fresh frozen cadaveric specimen was utilized. Under the guidance of a navigation robotic arm and CT, a puncture was made through the lateral thoracic wall into the posterior edge of the T9 vertebra, mimicking the pre-planned surgical trajectory. Once the puncture reached the midpoint of the vertebral body, bone cement was injected to penetrate the spinal canal along the posterior longitudinal ligament. CT scans confirmed successful cement distribution behind the T9 vertebra, simulating OPLL preparation. Subsequently, the endoscopic SBT was performed by entering the vertebral body through the ipsilateral intervertebral foramen and the contralateral partial pedicle. Bilateral center-directed resection of the vertebral body created a trough-like defect accommodating the simulated OPLL. Using suture anchors, the OPLL mass was anchored, sunk, and secured within the vertebral trough to achieve ventral decompression of the spinal canal. Results: A bone cement model of thoracic OPLL in cadaveric specimen was successfully established with the simulated OPLL occupying 49% of the posterior margin of the T9 vertebra. Endoscopic SBT surgery smoothly decompressed the ventral side of the thoracic spinal cord, and postoperative CT scans confirmed the simulated OPLL was successfully embedded and fixed within the vertebra using the endoscopic SBT technique, with a sagittal diameter restoration rate of 218%. Conclusions: Endoscopic SBT is an innovative thoracic endoscopic technique, which has demonstrated in cadavers to achieve decompression of the spinal canal by sinking simulated segmental thoracic OPLL into the vertebral body.