CAJ | 학술논문

目的探讨胸椎管狭窄症硬膜骨化的手术治疗策略并观察其疗效.方法 2004年1月至2008年6月共收治胸椎管狭窄症患者108例,经手术证实硬膜骨化29例.男19例,女10例;年龄42～74岁,平均56.4岁.病程2～48个月,平均13个月.发生于上胸段(T1～T4)4例,中胸段(T5～T8)5例,下胸段(T9～T12)20例.29例硬膜骨化患者均行后路椎板切除术.16例切开硬膜将骨化硬膜和骨化黄韧带一并切除;13例去薄椎板和致压骨块,最终使硬膜膨胀漂浮,硬膜表面带有部分骨化的残迹.术后1、3、12个月随访时进行日本矫形外科学会(JOA)评分.结果平均手术时间140 min,平均出血量300 ml.16例切开硬膜者:11例术中修补,伤口放置引流管,24 h后拔除,7例出现脑脊液漏,3～5 d愈合;5例未修补硬膜,密集缝合肌层关闭伤口,术后伤口未放置引流管,脑脊液漏5～7 d愈合.13例漂浮法使硬膜膨胀的病例均未出现脑脊液漏.所有病例均未出现蛛网膜下腔感染,原有神经系统症状未加重.术后根据JOA评分改善率判定治疗结果:优22例,良5例,可2例.结论对胸椎管狭窄症硬膜骨化采用切开硬膜将骨化的硬膜与骨化的黄韧带一并切除,以及去薄椎板和骨化块使硬膜漂浮膨胀的方法安全、可靠.手术疗效满意,硬膜骨化不影响手术预后,但增加手术的难度和风险.
목적 탐토흉추관협착증경막골화적수술치료책략병관찰기료효.방법 2004년1월지2008년6월공수치흉추관협착증환자108례,경수술증실경막골화29례.남19례,녀10례;년령42～74세,평균56.4세.병정2～48개월,평균13개월.발생우상흉단(T1～T4)4례,중흉단(T5～T8)5례,하흉단(T9～T12)20례.29례경막골화환자균행후로추판절제술.16례절개경막장골화경막화골화황인대일병절제;13례거박추판화치압골괴,최종사경막팽창표부,경막표면대유부분골화적잔적.술후1、3、12개월수방시진행일본교형외과학회(JOA)평분.결과 평균수술시간140 min,평균출혈량300 ml.16례절개경막자:11례술중수보,상구방치인류관,24 h후발제,7례출현뇌척액루,3～5 d유합;5례미수보경막,밀집봉합기층관폐상구,술후상구미방치인류관,뇌척액루5～7 d유합.13례표부법사경막팽창적병례균미출현뇌척액루.소유병례균미출현주망막하강감염,원유신경계통증상미가중.술후근거JOA평분개선솔판정치료결과:우22례,량5례,가2례.결론 대흉추관협착증경막골화채용절개경막장골화적경막여골화적황인대일병절제,이급거박추판화골화괴사경막표부팽창적방법안전、가고.수술료효만의,경막골화불영향수술예후,단증가수술적난도화풍험.
Objective To explore the surgical strategies of thoracic spinal stenosis with dural ossification. Methods One-hundred and eight patients with thoracic spinal stenosis were treated. Dural ossification was found in 29 cases during operation from January 2004 to June 2008. There were 19 males and 10females, with an average age of 56.4 years (42-74 years). The course of disease was 13 months (2-48months). The lesion was located in T1-T4 in 4 cases, T5-T8 in 5 cases, and T9-T12 in 20 cases. All the patients were treated by posterior lamina resection. Both ossificated dural and ossificated yellow ligament were resected in 16 patients. Decompression was performed with partial ossification remaining on dural surface in 13 cases. JOA score was used to evaluate the outcomes 1, 3 and 12 months after operation. Results The average operation time was 140 min, and average bleeding was 300 ml. Dural incisions were repaired with a wound drainage in 11 cases. Seven cases appeared cerebrospinal fluid leakage which healed in 3-5 days.Dural incisions were not repaired without wound drainage in 5 cases. Cerebrospinal fluid leakage occurred in these cases healed in 5-7 days. Thirteen cases treated with floating method did not appear cerebrospinal fluid leakage. All patients did not undergo subarachnoid infection and the aggravation of original nervous system symptoms. According to JOA score, all patients were evaluated as excellent in 22 cases, good in 5 and fair in 2 cases, and excellent and good rate was 93%. Conclusion For thoracic spinal stenosis with dural ossification, resection of both ossificated dural and ossificated yellow ligament and complete decompression with partial ossification remaining on dural surface is safe and reliable. Dural ossification does not influence the prognosis, but increase operative difficulty and risk.