胸椎黄韧带骨化症手术治疗效果分析

目的:探讨胸椎黄韧带骨化症手术方法和疗效。方法:回顾性分析自2006年10月至2009年10月采用半关节突全椎板切除术手术方法治疗胸椎黄韧带骨化症6例,男4例,女2例;年龄45～66岁,平均55.2岁。术后采用JOA评分法从下肢运动、膀胱功能两方面对疗效进行评定。结果:所有患者获随访,时间2～18个月,平均10.5个月。下肢功能按JOA评定标准:优4例,良1例,差1例。1例差的患者因为脊髓压迫时间过长,MRI显示T2加权像脊髓高信号导致不可逆的脊髓变性及合并有精神分裂症。结论:半关节突全椎板切除减压是胸椎黄韧带骨化症目前较好的手术方式,术中彻底减压和实时的脊髓保护是手术取得成功的关键。

Surgical treatment of thoracic ossification of ligamentum flavum and therapeutic effects analysis

Objective: To investigate the surgical treatment of thoracic ossification of the ligamentum flavum(TOLF) and analysis of the therapeutic effects. Methods: Six patients with thoracic ossification of the ligamentum flavum were retrospectively studied from October 2006 to October 2009. All of the patients in this group were treated by en bloc hemi-articular process laminectomy. There were 4 males and 2 females,ranging in age from 45 to 66 years,averaged 55.2 years. The evaluate factors including the preoperative and postoperative JOA scores,and the function of the urinary bladder were analyzed. Results: All the 6 patients were followed after operation. The mean followed-up duration was 10.5 months,ranging from 2 to 18 months. According to JOA evaluation criteria,4 patients got an excellent result,1 good and 1 bad. The one patient with bad result had spinal cord compressed for too long time,and the T₂-weight MRI showed nonreversible degeneration of spinal cord and combined with schizophrenia. The clinical symptoms improved with varying degrees. Conclusion: The en bloc hemi-articular process laminectomy is an effective method for ossification of the thoracic ligamentum flavum. A thorough decompression and real-time protection of the spinal cord is the key to the success of surgery.