全椎板薄化层揭法治疗胸椎管狭窄症

目的 探讨采用全椎板薄化层揭法治疗由胸椎黄韧带骨化(ossification of ligamentum flavum,OLF)和胸椎后纵韧带骨化(ossification of posterior longimental ligament,OPLL)引起的胸椎管狭窄症的特点及疗效.方法 回顾121例胸椎管狭窄症患者的临床资料,男51例,女70例;年龄45～71岁,平均54.8岁;单纯胸椎OLF 72例,单纯胸椎OPLL 21例,合并胸椎OLF和OPLL 28例.对胸椎OLF和胸椎OPLL均采用全椎板薄化层揭法进行治疗.统计病变的节段与平面,测量椎体矢状位夹角,计算椎管面积残余率.采用日本骨科协会(Japanese Orthopaedic Association,JOA)评分系统对术前、术后脊髓功能进行评分并比较.结果 胸椎OLF的发病,下胸椎占77.0%(137/178);胸椎OPLL,上胸椎占81.1%(43/53).121例患者平均上胸椎后凸角31.5°±6.8°,下胸椎后凸角9.4°±3.5°.椎管面积残余率＞80%时,JOA评分从术前的(7.7±1.4)分提高到术后的(9.5±1.6)分;椎管面积残余率在80%～50%时,JOA评分从(5.2±1.8)分改善到(8.6±2.1)分;椎管面积残余率＜50%时,JOA评分从(4.8±1.4)分改善到(5.6±1.3)分.结论 胸椎OLF好发于下胸椎,胸椎OPLL好发于上胸椎.术前椎管面积残余率对预后有重要意义.只要临床症状和影像学表现相对应,应尽早手术,手术应尽量切除骨化物.胸椎管狭窄症术后易复发,再次手术更应注意减压范围和减压技巧.

Laminar shelling decompression for treatment of thoracic spinal stenosis

Objective To investigate the clinical characteristics of laminar shelling decompression for the treatment of thoracic spinal stenosis.Methods One hundred and twenty-one patients with thoracic spinal stenosis were reviewed.Ages of these 51 male and 70 female patients ranged from 45 to 71 years (mean 54.8 years).There were 72 patients with thoracic ossification of ligamentum flavum(OLF),21 patients with thoracic ossification of posterior longimental ligament(OPLL)and 28 patients with thoracic OLF and OPLL.The lesion segmentum,kyphosis angle of thoracic vertebra and residual area of vertebral canal(RAVC)were measured.All these patients were treated with laminar shelling decompression.Preoperative and postoperative functional statuses were evaluated using a Japanese Orthopaedic Association(JOA)score.Results Thoracic OLF were found between T7 to T12 in 77.0% of the lesions;thoracic OPLL were found between T1 to T6 in 81.1% of the lesions.Of the 121 patients,the mean kyphosis angle was 31.5°±6.8° in upper thoracic spine and,9.4°±3.5° in lower thoracic spine.In patients whose RAVC were more than 80%,the pre- and postoperative mean JOA score was 7.7±1.4 and 9.5±1.6 respectively;RAVC more than 50%,5.2±1.8 and 8.6±2.1 respectively;RAVC less than 5%,4.8±1.4,and 5.6±1.3 respectively.Conclusion Thoracic OLF mostly occurred in lower thoracic spine,while thoracic OPLL mostly occurred in upper thoracic spine.The RAVC is a significant factor to the prognosis of thoracic spinal stenosis.As long as the clinical symptoms correspond with imaging findings,it is better to resect the whole ossification part as much as possible.Thoracic spinal stenosis often recurs after surgery.More attention to decompression ranges and decompression skills shoud be paied during revision surgery.