胸椎黄韧带骨化症外科治疗56例功能恢复相关分析

背景:胸椎黄韧带骨化症手术难度大,手术技巧要求高,处理不当易发生神经功能障碍加重。目的:分析胸椎黄韧带骨化症的手术方法及功能恢复情况。设计:病例分析。单位:解放军第二军医大学长征医院骨科。对象:长征医院骨科1996-08/2003-08收治的胸椎黄韧带骨化症患者56例。方法:所有患者进行手术治疗:①对于MRI,CT检查胸椎黄韧带骨化为局灶型,病变范围不超过2个节段,采用单纯后路椎管后壁切除减压,共19例。②涉及2个以上节段,可采用单侧开门整块椎板撬拨法,共29例。③胸椎同一平面胸椎黄韧带骨化症合并胸椎间盘突出或后纵韧带骨化时,采用后正中入路 侧后方入路的次环状减压治疗,共8例。主要观察指标:根据Epstein标准评价功能恢复情况,优:感觉、运动恢复到接近正常;良:脊髓功能明显改善,借支具行走;可:感觉、运动功能小部分恢复,仍不能行走;差:无效或加重。结果:55例随访1年以上,1例随访至术后2个月。①其中功能恢复优39例,良8例,可5例,差4例。②术后症状恢复依次为束带感消失,肌张力下降,麻木减轻。③术后3～6个月是恢复较快的时期,部分患者术后1年仍有改善,2年以后基本无再进步;完全截瘫者恢复较差;病史长、截瘫重者恢复亦差。结论:胸椎黄韧带骨化所导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。

Correlation analysis of post-operation functional restoration in surgical treatment of 56 patients with ossification of ligamentum fiavum in thoracic spine

BACKGROUND: It is difficult to conduct the operation of ossification of ligamentum flavum (OLF) in thoracic spine, and the operation needs complecated operative skill, and unmerited disposal tends to worsen neurological dysfunction.OBJECTIVE: To analyze the operative method for OLF of thoracic spineand functional restoration.DESIGN: Case analysis.SETTING: Department of Orthopaedics, Changzheng Hospital, SecondMilitary Medical University of Chinese PLA.PARTICIPANTS: Totally 56 patients with OLF of thoracic spine, whowere treated at the Department of Orthopaedics, Changzheng Hospital fromAugust 1996 to August 2003.METHODS: The operative therapy was performed in all the patients, and the method was determined by the results of MRI and CT examination: ①The 19 patients, whose OLF in thoracic spine was focal type, and range of lesion did not exceed two segments, were treated with simple resection and decompres sion in posterior wall of vertebral canal. ②Fenestration and sledging-allocating manipulation in the whole piece unilateral lamina of vertebra were carried out in 29 cases involving more than 2 segments. ③If coplanar OLF in thoracic spine combined with protrusion of thoracic spine disc or ossification of posterior longitudinal ligament, decompression of posterior midline approach+posterior lateral approach was performed, totally 8 cases.MAIN OUTCOME MEASURES: Post-operation functional restoration was evaluated with Epstein standard, excellent: recovery of sensation and exercise was near to normal; good: spinal cord function was improved significantly, and permitted to walk with brace; fair: small partial restoration of sensory and motor function, unable to walk; bad: Inefficiency or becoming severe.RESULTS: A total of 55 cases were followed up for more than one year and 1 case only for two months after operation. ①Functional restoration: excellent: 39 cases; good: 8 cases; fair: 5 cases; bad: 4 cases. ②Symptom recovery after operation was confirmed by disappearance of tight sensation, reduction of muscular tension, relieving of numbness in order. ③The recovery was rapid for 3 to 6 months after operation. Part of patients' condition was still ameliorating during one year after operation, and rare advancement 2 years later. The recovery of complete paraplegics was bad, so was the severe paraplegia with long history. CONCLUSION: Compressive myelopathy caused by OLF in thoracic spine should be treated in an earlier period by operation. Resection and decompression of posterior wall of thoracic spine and decompression of posterior approach could be choosed according to different condition.