飘浮法椎管后壁切除术治疗胸椎黄韧带骨化症

目的总结椎管后壁切除术治疗胸椎黄韧带骨化症的手术方法、技巧,提高手术疗效,避免或减少并发症的发生。方法对21例胸椎黄韧带骨化症患者行漂浮法椎管后壁切除术,即用尖嘴咬骨钳、高速磨钻、神经剥离子、超薄型椎板咬骨钳等器械对拟切除的椎板及骨化黄韧带进行逐层切除、薄化,直至致压物变薄呈漂浮状再予以分离、切除。术中术后使用激素和脱水剂保护脊髓。结果经配对t检验结果显示,手术前后平均JOA评分之间的差异有高度统计学意义(P<0.01),且手术后大于手术前,即手术后脊髓功能较手术前明显好转。手术疗效优良率80.95%,有效率90.48%。术后并发脊髓缺血再灌注损伤1例,血肿形成1例,脑脊液漏5例。结论对胸椎黄韧带骨化症患者,使用漂浮法切除椎管后壁,具有对脊髓侵袭小的优点,辅以药物治疗,使脊髓功能获得明显改善。

Treating Ossification of Ligamentum Flavum with En Bloc Laminectomy Using "Lamina Floating"

Objective To summarize the surgical methods and techniques of treating ossification of ligamentum flavum（OLF）with en bloc laminectomy using ＂lamina floating＂ to improve surgical therapeutic effect and minimize/or prevent complications.Methods En bloc laminectomy using ＂lamina floating＂ was performed on 21 patients with OLF,during which the lamina to be removed and ossified ligamentum flavum were removed layer by layer and thinned until lamina became floated,followed by further separation and removal.Hormones and dehydrating agent were used to in and after operation to protect spinal cord.Results Paired t-test showed the average JOA grading before and after surgery was statistically and significantly different（P〈0.01）.The functions of spinal cord were apparently better after surgery.The acceptance rate of surgical effect was 80.95% and the effective rate 90.48%.One case was complicated with injury form ischemia of spinal cord and re-infusion,one case had post-surgery hematoma,and five cases were found to be complicated with leakage of cerebrospinal.Conclusions For patients with OLF,en bloc laminectomy using ＂lamina floating＂ technique has limited impairment on spinal cord.Complemented with medication,this method can improve spinal functions significantly.