CAJ | 학술논문

目的探讨胸椎后纵韧带骨化致椎管狭窄症的临床特征和手术治疗方法.方法 2004年1月至2009年3月,手术治疗胸椎后纵韧带骨化致椎管狭窄症患者21例,男13例,女8例;年龄34～71岁,平均51.2岁;病程2～50个月,平均11个月.病变位于上胸段(T1～T4)4例,中胸段(T5～T8)7例,下胸段(T9～T12)10例;合并黄韧带骨化9例,合并颈椎后纵韧带骨化8例.11例行后路椎板切除术,10例行侧前方减压术.结果后路椎板切除手术时间90～240 min,平均140 min.侧前方减压手术时间110～360min,平均240min.术后患者症状未加重,未出现神经系统并发症、无蛛网膜下腔感染和伤口感染.术后6个月日本骨科协会(Japanese Orthopaedic Association,JOA)评分为8～15分,平均(9.17±1.63)分;其中神经功能改善率8例为优,6例为良,5例为可,2例为差,优良率为66.7%.术后12个月JOA评分为8～15分,平均(10.23±1.64)分;其中神经功能改善率8例为优,7例为良,4例为可,2例为差,优良率为71.4%.结论胸椎后纵韧带骨化致椎管狭窄临床表现多样,常合并颈椎后纵韧带骨化和黄韧带骨化,后路椎板切除术和侧前方减压术有较好疗效.
목적 탐토흉추후종인대골화치추관협착증적림상특정화수술치료방법.방법 2004년1월지2009년3월,수술치료흉추후종인대골화치추관협착증환자21례,남13례,녀8례;년령34～71세,평균51.2세;병정2～50개월,평균11개월.병변위우상흉단(T1～T4)4례,중흉단(T5～T8)7례,하흉단(T9～T12)10례;합병황인대골화9례,합병경추후종인대골화8례.11례행후로추판절제술,10례행측전방감압술.결과 후로추판절제수술시간90～240 min,평균140 min.측전방감압수술시간110～360min,평균240min.술후환자증상미가중,미출현신경계통병발증、무주망막하강감염화상구감염.술후6개월일본골과협회(Japanese Orthopaedic Association,JOA)평분위8～15분,평균(9.17±1.63)분;기중신경공능개선솔8례위우,6례위량,5례위가,2례위차,우량솔위66.7%.술후12개월JOA평분위8～15분,평균(10.23±1.64)분;기중신경공능개선솔8례위우,7례위량,4례위가,2례위차,우량솔위71.4%.결론 흉추후종인대골화치추관협착림상표현다양,상합병경추후종인대골화화황인대골화,후로추판절제술화측전방감압술유교호료효.
Objective To study the clinical features and surgical strategies of thoracic spinal stenosis caused by ossification of posterior longitudinal ligament(OPLL).Methods From January 2004 to March 2009,21 cases of thoracic spinal stenosis casued by OPLL,including 13 males and 8 females,received surgical treatments.Those cases aged from 34 to 71 years,with an average of 51.2 years old.The courses of disease were from 2 to 50 months,averaged 11 months.The lesions located in upper thoracic(T1-T4)for 4 cases,in middle thoracic(T5-T8)for 7 cases,in lower thoracic(T9-T12)for 10 cases.Nine cases were associated with ossification of ligamentum flavum(OLF),and 8 cases combined with cervical OPLL.Eleven cases received laminectomy and 10 cases received anterolateral decompression.Results The operation time was 90 to 240 min for posterior laminectomy with an average of 140 min,and 110 to 360 min for anterolateral decompression with an average of 240 min.All cases had no worse postoperative symptoms,neurological complications,subarachnoid cavity or wound infection.Japanese Orthopaedic Association(JOA)score was 8 to 15 with an average of 9.17±1.63 in 6 months after surgery.Nerve function improvement was excellent for 8 cases,good for 6 cases,fair for 5 cases and poor for 2 cases.The excellent and good rate was 66.7%.JOA score was 8-15,averaged 10.23±1.64,in 12 months after surgery.Nerve function improvement was excellent for 8 cases,good for 7 cases,fair for 4 cases,and poor for 2 cases.The excellent and good rate was 71.4%.Conclusion Thoracic spinal stenosis result from OPLL,which often combine with cervical OPLL and OLF,often show multiple manifestations.Posterior laminectomy and anterolateral decompression are suitable for those conditions.