棘突截骨椎管成形术治疗退行性腰椎疾病

目的采用棘突截骨椎管成形术治疗退行性腰椎疾病,术后进行临床与影像学评估。方法术式为后正中切口,显露一侧椎板后在棘突基底部截骨,并将棘突-韧带-骶棘肌推离对侧椎板,完成全椎板显露。切除椎板上、下缘和黄韧带,并潜式扩大中央椎管和神经根管或摘除椎间盘。应用此术式治疗退行性腰椎管狭窄症、腰椎间盘突出合并发育性腰椎管狭窄症、腰椎间盘中央型突出钙化、腰椎黄韧带骨化患者共37例。其中单节段减压24例,两节段减压13例。术后进行Oswestry疗效评分与影像学观察。结果术后1年随访34例,疗效优良率为82.4%;术后3年随访27例,疗效优良率为81.5%。术后CT显示椎管直径明显增加,棘突截骨愈合率为87%。结论棘突截骨椎管成形术操作简单,手术并发症少,对腰椎后柱张力带结构破坏小,主椎管和侧椎管减压充分,是治疗退行性腰椎疾病疗效较为满意的一种术式。     

棘突截骨椎管成形术治疗单纯性腰椎管狭窄症

目的　采用棘突截骨椎管成形术治疗单纯性腰椎管狭窄症 ,并进行临床与影像学评估。方法　手术方法为单侧椎板显露棘突基底截骨 ,将棘突 -韧带 -骶棘肌整体推离对侧椎板。切除椎板上下缘和黄韧带 ,潜式扩大椎管和摘除椎间盘。 35例退行性腰椎管狭窄症患者接受该手术 ,术后进行疗效评分 (Oswestry问卷 )和腰椎管直径测量。结果　术后 1年腰腿痛平均改善78.4% ,术后 4年平均改善 76 .3 % ,术后中期疗效下降不显著 (P >0 .0 5 )。术后CT显示椎管矢径平均增加 19.7% ,横径平均增加 17.5 % ,棘突截骨后原位愈合率为 91%。结论　棘突截骨椎管成形术操作简单 ,神经减压充分 ,手术并发症少 ,腰椎稳定性破坏轻。该术式治疗单纯性腰椎管狭窄症术后近、中期疗效和影像学评估满意     

棘突截骨椎管成形术治疗单纯性腰椎管狭窄症

目的：采用棘突截骨椎管成形术治疗单纯性腰椎管狭窄症,并进行临床与影像学评估。方法：手术方法为单侧椎板显像棘突基底截骨,将棘突－韧带－骶棘肌整体推离对侧椎板。切除椎板上下缘和黄韧带,潜式扩大椎管和摘除椎间盘。35例退行性腰椎管狭窄症患者接受该手术,术后进行疗效评分（Oswestry问卷）和腰椎管直径测量。结果：术后1年腰腿痛平均改善78．4％,术后4年平均改善76．3％,术后中期疗效下降不显著（P＞0．05）。术后CT显示椎管矢径平均增加19．7％, 横径平均增加17．5％,棘突截骨后原位愈合率为91％。结论：棘突截骨椎管成形术操作简单,神经减压充分,手术并发症少,腰椎稳定性破坏轻。该术式治疗单纯性腰椎管狭窄症术后近、中期疗效和影像学评估满意。     

退行性腰椎滑脱合并腰椎管狭窄症的手术策略和方法

目的 :评估椎管成形术、椎板减压融合术、减压融合固定术治疗退行性腰椎滑脱合并腰椎管狭窄症。方法 :16例稳定性腰椎滑脱患者接受棘突截骨椎管成形术 ,15例不稳定性腰椎滑脱患者接受椎板减压加后外侧融合术 ,14例不稳定性腰椎滑脱患者接受椎板减压椎间融合经椎弓根内固定术。术后进行疗效评分和影像学观察。结果 :术后 1年功能改善率 :椎管成形术为 85 .7% ,减压融合术为 84.8% ,固定融合术为 86.2 % ,各组疗效无显著差别 (P >0 .0 5 )。术后 4年功能改善率 :椎管成形术为 84.9% ,减压融合术为 75 .6% ,固定融合术为 84.6% ,减压融合术疗效下降显著 (P <0 .0 5 )。结论 :椎管成形术治疗稳定性腰椎滑脱 ,术后近中期疗效与影像学评估满意。椎板减压后外侧融合术治疗不稳定性腰椎滑脱 ,腰椎假关节发生率较高和术后中期疗效明显下降。椎板减压椎间融合内固定治疗不稳定性腰椎滑脱 ,术后中期疗效无明显改变     

棘突截骨椎管成形治疗发育性腰椎管狭窄合并椎间盘突出

目的　探讨发育性腰椎管狭窄合并椎间盘突出症的新术式。方法　采用棘突截骨椎管成形术治疗 34例发育性腰椎管狭窄合并椎间盘突出患者 ,术后随访 4年 ,进行 Oswestry疗效评分和椎管直径 CT测量。结果　本组术后 1年疗效优良率为 83.9%,术后 4年优良率为 81.5 %,疗效下降不显著 (P >0 .0 5 )。术后 1年腰椎 CT显示椎管直径显著增加 ,87%的棘突截骨后能原位融合。结论　棘突截骨椎管成形术操作简单 ,减压充分 ,腰椎破坏小。该术式治疗发育性腰椎管狭窄合并椎间盘突出症患者 ,术后近中期临床与影象学评估满意。     

单节段黄韧带骨化引起腰椎管狭窄的手术治疗

目的探讨保留腰椎板上1/3椎管减压术对黄韧带骨化性病变引起腰椎管狭窄症的手术疗效。方法对68例黄韧带骨化性病变引起的腰椎管狭窄并进行了保留腰椎板上1/3椎管减压术,对其临床资料进行回顾性分析。结果术前JOA评分平均(10.3±4.1)分,恢复到术后平均(22.3±5.8)分,恢复率为(63.8±22.4)%,未见神经功能恶化及腰椎不稳发生,临床疗效满意。结论保留腰椎板上1/3椎管减压术是一种治疗黄韧带骨化性病变引起的腰椎管狭窄症合理的术式。     

改良椎管成形术在腰椎管狭窄症的疗效观察

目的探讨改良椎管成形术治疗腰椎管狭窄症的临床疗效,及其对术后腰椎稳定性的影响。方法自2013-05-2015-02手术治疗74例腰椎管狭窄症患者:对照组38例采用传统的全椎板切除减压术;观察组36例采用改良椎管成形术治疗,术中以薄骨刀进行椎板截骨,待减压操作完成后,将截除的椎板及韧带予以回植,从而尽量保留了脊柱后柱结构的完整性。结果两组患者术后随访24-35个月,观察组回植的棘突椎板连接处均顺利愈合,愈合时间为6-12个月,平均8.7个月;其椎管矢状径、横径与术前相比,有明显增加(P0.05)。末次随访时,两组患者腰痛、下肢痛的VAS评分以及JOA评分均较术前有显著改善(P0.05)观察组末次随访时的腰痛VAS评分显著优于对照组(P0.05)。对照组有3例发生腰椎滑脱、2例发生腰椎不稳,总发生率为13.2%;观察组无一例腰椎不稳或滑脱现象。结论与传统全椎板切除减压术相比,采用改良的椎板棘突复合体截骨、原位回植椎管成形术式治疗腰椎管狭窄症,其疗效可靠,有利于进一步缓解腰部疼痛、维持腰椎术后的稳定性。     

改良Z型椎管扩大成形术治疗颈椎后纵韧带骨化症的远期疗效

[目的]探讨改良Z型单开门椎管扩大成形术治疗颈椎后纵韧带骨化症的远期疗效.[方法]对39例颈椎后纵韧带骨化症患者实施改良Z型单开门椎管扩大成形术,通过术前及术后的影像学检查、JOA评分进行远期疗效观察分析.[结果]随访5 ～7.5年,平均随访6.2年,JOA评分从术前的(8.3±3.2)分改善到术后的(13.8±2.5)分,平均改善率为58.6％,末次JOA评分为(12.6±3.5)分,平均改善率为55.8％.术后CT示门轴骨愈合良好,无再关门现象,MRI示脊髓受压解除,提示病理变化程度与远期疗效相关,术前MRI检查无脊髓信号改变者疗效优于信号异常者.[结论]改良Z型单开门椎管扩大成形术治疗颈椎后纵韧带骨化症,安全,有效,远期疗效确切,病理变化程度对治疗效果有明显影响.     

棘突椎板截骨回植椎管潜行扩大减压治疗腰椎管狭窄症

目的探讨棘突椎板截骨回植椎管潜行扩大减压治疗腰椎管狭窄症的临床效果。方法 2007年1月至2010年1月对28例腰椎管狭窄症患者,采用经棘突椎板截骨将椎管后部结构整块取下,潜行扩大椎管,处理完椎管内病变后再将后部结构原位回植固定。术前术后进行影像学观察及JOA疗效评分对比。结果 28例均获得随访,CT显示椎管矢状径术前平均为(13.5±2.5)mm,术后平均为(16.8±2.6)mm。JOA评分术前平均为(5.8±1.5)分,末次随访时平均为(23.2±2.0)分。术后6～14个月复查CT示椎板原位融和率为100%,未发现腰椎不稳和椎管再狭窄。结论棘突椎板截骨回植椎管潜行扩大减压术具有椎管显露充分、椎管后部结构完整保留、脊柱稳定性好、瘢痕黏连压迫硬脊膜及神经根发生率低等优点,是治疗腰椎管狭窄症一种行之有效的方法。     

全椎板截骨再植椎管扩大成形术治疗胸椎黄韧带骨化症

目的总结胸椎黄韧带骨化症导致胸椎椎管狭窄的影像学特点，探讨改良椎管减压术的临床疗效。方法胸椎黄韧带骨化症31例，男18例，女13例；年龄26—73岁，平均45．7岁。术前均行MR、CT检查以明确诊断。合并颈椎管狭窄3例、腰椎管狭窄5例，颈胸腰椎管狭窄同时存在者2例；合并胸椎后纵韧带骨化和椎间盘突出症9例。单节段3例，双节段12例，三节段11例，四节段以上5例。局限型6例，连续型17例，跳跃型8例。共94个病变节段，其中上胸段(T1～T4)23个节段、中胸段(T5～T8)19个节段、下胸段(T9-T12)52个节段。手术采用全椎板截骨原位再植椎管扩大成形术。对9例合并胸椎后纵韧带骨化和椎间盘突出者，在后方减压的同时，行切除椎管前方突出椎间盘的环脊髓减压及后路钉棒系统内固定。术后疗效评价参照Epstein标准。结果24例患者随访6—63个月，平均15个月。术后疗效优14例、良7例、可3例，优良率87．5％。1例因术后停用脱水药物过早引起下肢瘫痪症状加重；2例出现下肢静脉血栓；2例硬脊膜撕裂。结论MR结合CT检查是诊断胸椎黄韧带骨化症最有效的手段，全椎板截骨再植椎管扩大成形术安全可靠，疗效满意。     

后路全椎板减压＋胸椎弓根钉内固定术治疗胸椎黄韧带骨化的疗效分析

目的探讨后路全椎板减压＋胸椎弓根钉内固定术治疗胸椎黄韧带骨化的疗效。方法回顾性总结2002年至2008年间胸椎黄韧带骨化病例27例。患者术前均常规给予X线、CT及MRI检查。手术采用后路全椎板减压＋椎弓根钉内固定术。术后采用改良Macnab疗效评定标准及VAS评分,评价治疗效果。结果术后改良Macnab疗效评定标准,27例患者术后1年内优良率77．8％,手术总有效率85．2％,1年后优良率85．1％。VAS评分应用专用评分尺,患者总满意度为66．6％,1年后总满意度为75％。结论后路全椎板减压＋胸椎弓根钉内固定术为治疗胸椎黄韧带骨化安全有效的手术方式。     

合并腰椎疾患的下胸椎黄韧带骨化临床诊治

目的探讨合并腰椎疾患的下胸椎黄韧带骨化临床特点及诊治方法。方法下胸椎黄韧带骨化同时存在腰椎疾患的患者23例,诊断结合X线、椎管造影、CT、MRI检查,体征以肌张力增高和深反射异常为特点;患者均采用病变节段全椎板减压手术治疗。结果23例均获随访,时间10-36个月,手术减压1-3节胸椎椎板,患者在末次随访时都有不同程度的神经功能改善。术后功能恢复优4例,良13例,可6例。术后到末次随访时无一例患者因腰椎疾病而再次接受手术。结论合并腰椎疾患的下胸椎黄韧带骨化需要注意将客观体征与多种影像学检查相结合,尽早诊断、早期手术。     

Lumbar ligamentum flavum hematoma treated with endoscopy

Hematoma of the ligamentum flavum is a rare cause of neural compression, for which treatment has consisted of excising the hematoma via open surgical approaches, including total laminectomy or bilateral partial laminectomy. This article presents the first report of a microscope-assisted endoscopic decompression to resect a hematoma of the ligamentum flavum.A 52-year-old man presented with back and leg pain, as well as difficulty initiating micturation. Magnetic resonance imaging demonstrated an epidural mass at L5/S1 that was continuous with the facet joint. Visualization was obtained via an endoscope, and a reddish tan-brown solid mass was found beneath the ligamentum flavum. Thorough decompression of the cauda equine and nerve roots was undertaken. The patient's radicular leg pain and bladder function improved soon after the decompression. Histological examination of the ligamentum flavum revealed a consolidated hematoma with granulomatous change.A review of the English literature revealed 29 cases of hematoma in the lumbar ligamentum flavum. Surgical decompression in these patients was accomplished with a standard open approach through hemilaminectomy (n=11), total laminectomy (n=10), or laminectomy followed by posterior fixation (n=3). The literature review did not identify any case of hematoma of the lumbar ligamentum flavum that was treated endoscopically. We expect our case may expand the indications for the endoscope in spine surgery.     

节段性潜行减压治疗腰椎管狭窄症

目的：探讨中央型腰椎管狭窄的手术方式，讨论采用节段性潜行减压这一术式的可行性，方法：对35例病人，根据术前X线，CT，椎管造影等检查，针对性地对一个或两个或多个节段进行潜行减压，对伴有侧隐窝狭窄者同时给予扩大成形。结果：32例病人的获随访，随访时间6－48个月，平均30个月，优良率93．75％，结论：节段性潜行减压术治疗中央型腰椎管狭窄症，通过有限的椎板及关节突切除，能够潜行扩大椎管狭窄的中央部及侧隐窝，并能摘除增厚的黄韧带和退变的椎间盘，较好地保留了腰椎的后部结构，既能解除对马尾和神经根的压迫，又能保持后柱的稳定性，该方法对于后柱的稳定性优于传统的椎板切除术     

Symptomatic ossification of the anterior longitudinal ligament with stenosis of the cervical spine: a report of seven cases

Seven men with a mean age of 63.9 years (59 to 67) developed dysphagia because of oesophageal compression with ossification of the anterior longitudinal ligament (OALL) and radiculomyelopathy due to associated stenosis of the cervical spine. The diagnosis of OALL was made by plain lateral radiography and classified into three types; segmental, continuous and mixed. Five patients had associated OALL in the thoracic and lumbar spine without ossification of the ligamentum flavum. All underwent removal of the OALL and six had simultaneous decompression by removal of ossification of the posterior longitudinal ligament or a bony spur. All had improvement of their dysphagia. Because symptomatic OALL may be associated with spinal stenosis, precise neurological examination is critical. A simultaneous microsurgical operation for patients with OALL and spinal stenosis gives good results without serious complications.     

胸椎黄韧带骨化症的外科治疗

目的探讨胸椎黄韧带骨化症的诊断与手术治疗方法，分析其手术时机、手术技巧、手术效果及并发症处理。方法回顾性总结56例患者的外科治疗过程，采用胸椎管后壁切除减压及侧后方入路，术中体感诱发电位监护。结果术后55例经随访1年以上，1例随访2个月。39例，良8例，可5例，差4例。结论胸椎黄韧带骨化所致的脊髓压迫症须早期手术治疗，可根据不同情况选择胸椎管后壁切除减压及侧后方入路的次环状减压的手术方式。     

刺突截骨椎管成形术治疗退行性腰椎管狭窄症

目的：介绍刺突截骨椎管成形术及其应用,方法：采用该术式治疗37例退行性腰椎管狭窄症患者,术后进行疗效评分（Oswestry问卷）和腰椎管直径测量。方法：术后1年腰腿痛平均改善76％,术后4年平均改善74％,疗效下降不显著（P＞0．05）。术后CT显示腰椎管直径平均增加20％,刺突原位愈合率87％。结论：该术式操作简单,神经减压充分,手术并发症少,其治疗退行性腰椎管狭窄症术手近、中期疗效和影像学评估均满意。     

Thoracic cord compression caused by contiguous multilevel ossification of ligamentum flavum in Chinese patients

OBJECTIVE: To explore the epidemiology, clinical presentation, radiology and surgical treatment outcome in Chinese patients with myelopathy caused by contiguous multilevel ossification of ligamentum flavum. METHODS: Medical notes and imaging data of 18 Chinese patients (14 males and 4 females, aged 43-72 years, mean: 57 years) with myelopathy caused by contiguous multilevel ossification of ligamentum flavum were studied retrospectively in this article. The diagnosis was based on clinical examination, X-ray films, computerized tomography (CT) and magnetic resonance imaging (MRI) scanning results and pathological results. Sixteen patients were treated by laminectomy and two by laminoplasty. The average follow-up duration was 34 months (range, 28-49 months). The outcome was evaluated by Japanese Orthopaedics Association (JOA) score. RESULTS: The average time for occurring clinical symptoms was 7.5 months (range, 2 days-16 months). All the 18 cases presented with clinical evidences of chronic and progressive thoracic spinal cord compression, which included bilateral leg weakness, spastic gait, numbness in lower limbs, paresthesia in terminal and perineum, and urinary incontinence. Neurological examination revealed severe spastic paraparesis, absence of abdominal reflexes, and reduction of the sensory function below the compression level. The mean JOA score before operation was 3.6 (range, 0-6). MRI and CT scans of the thoracic spine confirmed the presence of contiguous multilevel ossification of the ligamentum flavum. The mean recovery rate after surgery in terms of JOA score was 66.3% (range, 33.3%-100%), with a mean final JOA score of 8.3. Thoracic decompression laminectomy or laminoplasty could result in a good postoperative outcome. CONCLUSIONS: Contiguous multilevel ossification of the ligamentum flavum is not a common cause of myelopathy in Chinese population and should be treated as early as possible. MRI and CT scan examinations may diagnose the presence of thoracic ossification of ligamentum flavum (OLF). Posterior decompression, especially with en bloc dissection of the laminae, can obtain satisfactory results.