CAJ | 학술논문

目的探讨胸椎黄韧带骨化合并后纵韧带骨化、胸椎后凸畸形及硬膜囊粘连的处理策略及疗效.方法 2003年1月至2009年12月,采用半关节突椎板整块切除治疗35例胸椎黄韧带骨化患者,男32例,女21例;年龄43～73岁,平均54.7岁;骨化黄韧带限于中上胸椎者18例,累及胸腰段者35例.对多节段及跳跃型黄韧带骨化患者,结合临床及影像学表现确定责任节段.对多节段黄韧带骨化合并后纵韧带骨化或胸椎后凸畸形(＞50°)时行多节段椎弓根固定并后凸畸形矫正;合并硬膜囊粘连时,采用粘连尾侧硬膜囊切开放出部分脑脊液,造成蛛网膜萎陷与硬脊膜分离,一并切除骨化或粘连的硬脊膜,尽量保留蛛网膜的完整性.采用日本骨科协会(Japanese Orthopaedic Association,JOA)评分(11分法)、Nurick分级和神经功能恢复率评价手术疗效.结果患者均获得随访,随访时间6个月至6年,平均18个月.术前JOA评分1～9分,平均(4.3±2.3)分;术后为5～11分,平均(8.3±1.8)分,两者比较差异有统计学意义.术后神经功能恢复率11%～80%,平均65.8%,其中优18例,良20例,可10例,差5例,优良率71.7%.术前Nurick分级为2～5级,平均3.7级;术后改善为2.3级.结论半关节突椎板整块切除治疗胸椎黄韧带骨化伴后纵韧带骨化或后凸畸形时,行椎弓根固定矫正后凸有助于神经功能的恢复;蛛网膜萎陷后硬脊膜切除可处理较重的硬膜囊粘连或骨化.
목적 탐토흉추황인대골화합병후종인대골화、흉추후철기형급경막낭점련적처리책략급료효.방법 2003년1월지2009년12월,채용반관절돌추판정괴절제치료35례흉추황인대골화환자,남32례,녀21례;년령43～73세,평균54.7세;골화황인대한우중상흉추자18례,루급흉요단자35례.대다절단급도약형황인대골화환자,결합림상급영상학표현학정책임절단.대다절단황인대골화합병후종인대골화혹흉추후철기형(＞50°)시행다절단추궁근고정병후철기형교정;합병경막낭점련시,채용점련미측경막낭절개방출부분뇌척액,조성주망막위함여경척막분리,일병절제골화혹점련적경척막,진량보류주망막적완정성.채용일본골과협회(Japanese Orthopaedic Association,JOA)평분(11분법)、Nurick분급화신경공능회복솔평개수술료효.결과 환자균획득수방,수방시간6개월지6년,평균18개월.술전JOA평분1～9분,평균(4.3±2.3)분;술후위5～11분,평균(8.3±1.8)분,량자비교차이유통계학의의.술후신경공능회복솔11%～80%,평균65.8%,기중우18례,량20례,가10례,차5례,우량솔71.7%.술전Nurick분급위2～5급,평균3.7급;술후개선위2.3급.결론 반관절돌추판정괴절제치료흉추황인대골화반후종인대골화혹후철기형시,행추궁근고정교정후철유조우신경공능적회복;주망막위함후경척막절제가처리교중적경막낭점련혹골화.
Objective To explore the strategy and outcomes of surgical treatment of thoracic ossification of ligamentum flavum(OLF),especially combined with ossification of posterior longitudinal ligament,thoracic kyphosis and epidural adhesion.Methods Fifty-three cases of thoracic OLF from January 2003 to December 2009 were reviewed retrospectively.All patients were treated by the methods of en bloc resection of semi-facet and lamina.All patients were followed up for more than half an year,including 32 males and 21 females,aged from 43 to 73 years(average 54.7 years).The lesions located in upper thoracic for 18 patients,and in thoracolumbar for 35 patients.For multi-level or jumping OLF patients,the responsible levels were determined by combination of images and clinical symptoms.For multi-level OLF with ossification of posterior longitudinal ligament(OPLL)or thoracic kyphosis(＞50°),multi-level pedicle screw fixation and correction of kyphosis were performed.For dural adhesion patients,part of cerebrospinal fluid was released with a caudal incision of dural sac resulting in collapse and epidural arachnoid separation.Ossific and adhesion dura mater were removed with integrity of arachnoid.The surgical outcomes were evaluated with preoperative and postoperative thoracic Japanese Orthopaedic Association(JOA)score,Nurick grade and neurologic functional recovery ratio.Results Fifty-three cases were followed up for 6 months to 6 years,with an average of 18 months.The average preoperative JOA score was 4.3±2.3,which significantly increased to 8.3±1.8 after operation.Postoperative neurologic functional recovery rates were 11% to 80%(average 65.8%),including excellent in 18 cases,good in 20,fair in 10,and poor in 5.The excellent or good rate was 71.7%.The mean preoperative Nurick grade was 3.7(2-5 grade)and decreased to 2.3 grade after operation.Conclusion En bloc resection of semi-facet and lamina is a safe and effective method for treatment of thoracic OLF.For the patients with OPLL or kyphosis,pedicle screws fixation and kyphosis correction was beneficial for recovery of neurologic function of thoracic OLF patients.