中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2012年
2期
19-21
,共3页
骨化,后纵韧带%减压术,外科%椎板切除术%治疗结果
骨化,後縱韌帶%減壓術,外科%椎闆切除術%治療結果
골화,후종인대%감압술,외과%추판절제술%치료결과
Ossification of posterior longitudinal ligament%Decompression,surgical%Laminectomy%Treatment outcome
目的 探讨胸椎黄韧带骨化症的发病机制及手术方法.方法 回顾性分析经手术治疗的56例胸椎黄韧带骨化症患者的影像学与临床资料.所有患者采用全椎板切除加后外侧融合术,全椎板切除方法包括整块全椎板切除术与椎板分解切除术；手术疗效采用日本骨科协会(JOA)评分法进行评价.结果 56例患者共累及237个节段,以下胸段最为多见,占57.4％(136/237).术后随访18 ～70(25.00±11.56)个月.根据最后一次随访结果,56例患者中优25例,良20例,无变化6例,差5例,优良率80.4％(45/56).根据骨化巢形态,各型手术优良率分别为外侧型83.3％(5/6)、弥漫型82.4％(14/17)、厚结节型78.8％( 26/33).应用整块全椎板切除术24例,其中4例厚结节型中有2例术后脊髓损伤加重；应用椎板分解切除术32例,其中29例厚结节型中仅2例术后脊髓损伤加重.结论 局部应力因素是胸椎黄韧带骨化形成的主要原因之一；全椎板切除加后外侧融合术是治疗本病的理想手术方法,其中外侧型、弥漫型可采用整块全椎板切除术,而厚结节型采用椎板分解切除术更为安全.
目的 探討胸椎黃韌帶骨化癥的髮病機製及手術方法.方法 迴顧性分析經手術治療的56例胸椎黃韌帶骨化癥患者的影像學與臨床資料.所有患者採用全椎闆切除加後外側融閤術,全椎闆切除方法包括整塊全椎闆切除術與椎闆分解切除術；手術療效採用日本骨科協會(JOA)評分法進行評價.結果 56例患者共纍及237箇節段,以下胸段最為多見,佔57.4％(136/237).術後隨訪18 ～70(25.00±11.56)箇月.根據最後一次隨訪結果,56例患者中優25例,良20例,無變化6例,差5例,優良率80.4％(45/56).根據骨化巢形態,各型手術優良率分彆為外側型83.3％(5/6)、瀰漫型82.4％(14/17)、厚結節型78.8％( 26/33).應用整塊全椎闆切除術24例,其中4例厚結節型中有2例術後脊髓損傷加重；應用椎闆分解切除術32例,其中29例厚結節型中僅2例術後脊髓損傷加重.結論 跼部應力因素是胸椎黃韌帶骨化形成的主要原因之一；全椎闆切除加後外側融閤術是治療本病的理想手術方法,其中外側型、瀰漫型可採用整塊全椎闆切除術,而厚結節型採用椎闆分解切除術更為安全.
목적 탐토흉추황인대골화증적발병궤제급수술방법.방법 회고성분석경수술치료적56례흉추황인대골화증환자적영상학여림상자료.소유환자채용전추판절제가후외측융합술,전추판절제방법포괄정괴전추판절제술여추판분해절제술；수술료효채용일본골과협회(JOA)평분법진행평개.결과 56례환자공루급237개절단,이하흉단최위다견,점57.4％(136/237).술후수방18 ～70(25.00±11.56)개월.근거최후일차수방결과,56례환자중우25례,량20례,무변화6례,차5례,우량솔80.4％(45/56).근거골화소형태,각형수술우량솔분별위외측형83.3％(5/6)、미만형82.4％(14/17)、후결절형78.8％( 26/33).응용정괴전추판절제술24례,기중4례후결절형중유2례술후척수손상가중；응용추판분해절제술32례,기중29례후결절형중부2례술후척수손상가중.결론 국부응력인소시흉추황인대골화형성적주요원인지일；전추판절제가후외측융합술시치료본병적이상수술방법,기중외측형、미만형가채용정괴전추판절제술,이후결절형채용추판분해절제술경위안전.
Objective To investigate the pathogenesy and operation method in patients with ossification of thoracic ligamentum flavum.Methods The imaging and clinical data of 56 patients who underwent laminectomy combined with posterolateral fusion were studied retrospectively.The method of laminectomy included enbloc laminectomy and decomposed laminectomy.Postoperative outcomes were evaluated according to a recovery scale in terms of JOA score.Results The patients were followed up for 18-70 (25.00 ± 11.56) months.There were a total of 237 ossified segments in this series,57.4％(136/237)located in lower thoracic segments.According to the configuration of ossification on CT scans,lateral type occurred in 6 patients,diffuse type in 17 patients and thickened nodular type in 33 patients.All patients with lateral type and majority of patients with diffuse type were treated with enbloc laminectomy,and the rate of fineness of postoperative outcome was 83.3％ (5/6),82.4％ ( 14/17 ) respectively.Most of the patients with thickened nodular type were treated with decomposed laminectomy,and the rate of fineness of postoperative outcome was 78.8％ (26/33).Four patients with thickened nodular type were performed with enbloc laminectomy,2 of them resulted in deteriorated myelopathy.Twenty-nine patients with thickened nodular type were performed with decomposed laminectomy,however,only 2 of them resulted in worse outcomes.Conclusions The pathogenesis of ossification of thoracic ligamentum flavum is mainly due to the localizedmechanical stress.Laminectomy combining with lateral fusion may be the ideal method for the treatment of this condition.Furthermore,enbloc laminectomy is suitable for the patients in lateral type and diffuse type according to the configuration of ossifications.For the thickened nodular type,decomposed laminectomy is favorable.
