采用經椎間隙脊髓環(huán)形減壓術治療嚴重胸椎后縱韌帶骨化癥
發(fā)布時間：2018-10-19 14:37
【摘要】：目的:探討采用后路經椎間隙脊髓環(huán)形減壓術治療嚴重胸椎后縱韌帶骨化癥安全有效的手術方法與療效評價。方法:自2010年05月至2014年05月,15例合并有后縱韌帶骨化(OPLL)、侵占率超過50%以上的胸椎管狹窄患者行后路環(huán)形減壓,其中男性患者9例,女男性患者6例,年齡42-69歲,平均56.3歲。術前均有嚴重脊髓壓迫癥狀。手術從后路正中入路,先于減壓節(jié)段相鄰的上下兩個椎體,預置椎弓根螺釘道,然后采用“揭蓋法”分別去除壓迫節(jié)段椎管的后壁,完成脊髓背側的減壓。經上、下關節(jié)突關節(jié)處,切除關節(jié),向外側推開肋間神經,顯露椎體外間隙及椎間盤組織,切除椎間盤,并鑿除后縱韌帶骨化下椎體松質骨。分離硬脊膜腹側粘連,用特制工具切除后縱韌帶上下邊緣,壓塌,取出后縱韌帶骨化塊,經一側或兩側完成脊髓腹側的減壓。最后置入椎弓根釘,并行椎間植骨。術后隨訪(平均隨訪21.5月)行CT及MRI掃描,采用JOA評分及Frankel分級評價脊髓神經功能術前及術后情況,Otani評分系統(tǒng)行術后療效評估并計算臨床優(yōu)良率,評價治療效果。結果:14例患者術后即有明顯脊髓神經功能改善,1例出現單側下肢肌力一過性下降,3例術后腦脊液漏。術后隨訪無胸椎不穩(wěn),無內固定松動斷裂。術中分離硬膜與骨化的后縱韌帶粘連導致腦脊液漏3例。手術時間180min-300min,平均為240min;出血量150ml-270ml,平均出血量168ml。Frankel分級改善明顯,術前的平均JOA評分3.5±0.98,至末次隨訪JOA評分提高至9.0±0.90,較術前明顯改善(P0.05)。根據Otani評分標準,優(yōu)9例,良5例,可1例,差0例;優(yōu)良率為93.3%。結論:采用后路經椎間隙行脊髓環(huán)形減壓治療嚴重胸椎后縱韌帶骨化,可在較小的顯露范圍內,使用自主研制特殊手術工具安全完成前方骨塊切除,脊髓減壓充分,術后療效肯定。
[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 鹵0.98, and the last follow-up JOA score increased to 9.0 鹵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.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3
本文編號：2281436
[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 鹵0.98, and the last follow-up JOA score increased to 9.0 鹵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.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3
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