椎板薄化分解揭盖法治疗胸椎黄韧带骨化合并脊髓病

摘要

目的 探讨椎板薄化分解揭盖法治疗胸椎黄韧带骨化合并脊髓病的疗效.方法 1999年1月至2009年1月,采用椎板薄化分解揭盖减压、植骨融合术治疗胸椎黄韧带骨化合并脊髓病患者126例,男73例,女53例;年龄35～71岁,平均50.2岁.压迫位于上胸段28例,中胸段32例,下胸段66例.采用改良日本骨科协会(Japanese Orthopaedic Association,JOA)下肢运动功能评分、括约肌功能评分以及参照Epstein和Schwall标准评估疗效.摄胸椎正、侧位X线片,行CT及MRI扫描,观察植骨融合情况.结果 116例患者获得随访,随访时间12～96个月,平均49.5个月.术前括约肌功能JOA评分为(1.981±0.543)分,术后为(2.654±0.413)分;术前下肢运动功能JOA评分为(1.196±0.964)分,术后为(3.720±0.709)分;术前及术后比较差异均有统计学意义.按Epstein和Schwall评分标准,优73例,良31例,可9例,差3例;优良率89.7%.术后6例发生脊髓损伤,给予营养神经药物治疗后好转;5例发生脑脊液漏,给予床尾抬高30°,行保守治疗治愈;2例发生切口浅表感染,给予换药处理后愈合.术后6个月111例患者植骨融合;末次随访时,所有患者植骨均获得骨性融合.结论 椎板薄化分解揭盖法对脊髓侵袭小,手术安全性可靠,疗效确切.%Objective To evaluate the effects of the laminar thinned-segmented decompression technique in the treatment of thoracic ossification of ligamentum flavum with spondylotic myelopathy.Methods From January 1999 to January 2009,126 cases undergone the laminar thinned-segmented decompression.There were 73 males and 53 females with an average age of 50.2 years(range from 35 to 71 years).The affected segments located in upper thoracic spine in 28 cases,in mid-thoracic spine in 32 cases and in lowerthoracic spine in 66 cases.The postoperative outcomes were evaluated by Epstein and Schwall criteria,postoperative Japanese Orthopaedic Association(JOA)sphincter function score and JOA motor function score.All cases were examined by X-ray,CT and MRI to evaluate bone fusion.Results One hundred and sixteen cases were followed up from 12 to 96 months,with an average of 49.5 months.Post-operative JOA sphincter function score was 2.654±0.413 which had been significantly improved compared with the pre-operative score(1.981±0.543).Postoperative JOA motor function score was 3.720±0.709,which was significantly increased compared with the pre-operative score which was 1.196±0.964.According to Epstein and Schwall criteria,the clinical outcomes were excellent in 73 cases,good in 31 cases,fair in 9 cases and bad in 3 cases,and the excellent and good rate was 89.7%.Postoperative complications included spinal cord injury(6 cases),leakage of cerebrospinal fluid(5 cases),and infection of the incision(2 cases).Six months after operation,111 cases has achieved bone fusion,and all cases got bone fusion at the last follow up time.Conclusion The laminar thinned-segmented decompression technique is preferable to treat thoracic ossifcadon of ligamentum flavum with spondylotic myelopathy.