CAJ | 학술논문

目的：探讨半关节全椎板分段切除减压对连续多节段重度胸椎黄韧带骨化症的治疗效果及手术技巧。方法2008年1月至2010年1月，26例连续多节段重度胸椎黄韧带骨化症患者接受全椎板分段切除减压治疗，其中男11例，女15例；平均51.2(43～69)岁。所选患者均为连续多节段胸椎黄韧带骨化，其中T5～8椎3例，T5～9椎2例，T6～9椎2例，T6～11椎2例，T7～10椎3例，T7～11椎3例，T8～11椎8例，T7～T12椎2例，T8～L1椎1例。采用改良JOA评分法(11分)和Nurick分级评价神经减压效果。结果本组患者手术均安全顺利完成，减压节段3～5个，平均3.7个。手术时间3.0～5.5 h，平均4.1 h，出血量900～2100 ml，平均1300 ml。术后出现脑脊液漏21例。术后6例发生短暂脊髓损伤加重，另1例术后症状改善不明显，但未加重。未发生切口感染。随访12～36个月，平均24.4个月。术后JOA评分与术前比较有较大改善，评分术前为3.00±2.32，术后2周为7.23±2.18，差异有统计学意义( P＜0.05)。Nurick分级与术前比较，9例较术前提高3级，12例提高2级，4例提高1级，1例未提高。末次随访时无加重病例。结论半关节全椎板分段切除减压治疗连续多节段重度胸椎黄韧带骨化症安全、可靠，疗效满意。应特别注意其手术技巧。
목적：탐토반관절전추판분단절제감압대련속다절단중도흉추황인대골화증적치료효과급수술기교。방법2008년1월지2010년1월，26례련속다절단중도흉추황인대골화증환자접수전추판분단절제감압치료，기중남11례，녀15례；평균51.2(43～69)세。소선환자균위련속다절단흉추황인대골화，기중T5～8추3례，T5～9추2례，T6～9추2례，T6～11추2례，T7～10추3례，T7～11추3례，T8～11추8례，T7～T12추2례，T8～L1추1례。채용개량JOA평분법(11분)화Nurick분급평개신경감압효과。결과본조환자수술균안전순리완성，감압절단3～5개，평균3.7개。수술시간3.0～5.5 h，평균4.1 h，출혈량900～2100 ml，평균1300 ml。술후출현뇌척액루21례。술후6례발생단잠척수손상가중，령1례술후증상개선불명현，단미가중。미발생절구감염。수방12～36개월，평균24.4개월。술후JOA평분여술전비교유교대개선，평분술전위3.00±2.32，술후2주위7.23±2.18，차이유통계학의의( P＜0.05)。Nurick분급여술전비교，9례교술전제고3급，12례제고2급，4례제고1급，1례미제고。말차수방시무가중병례。결론반관절전추판분단절제감압치료련속다절단중도흉추황인대골화증안전、가고，료효만의。응특별주의기수술기교。
Objective To investigate the clinical outcomes and surgical techniques of hemi-articular total laminectomy and segmental decompression for severe continuous multi-segmental thoracic ossiifcation of ligamentum lfavum ( OLF ).Methods From January 2008 to January 2010, 26 patients with severe continuous multi-segmental thoracic OLF underwent the treatment of total laminectomy and segmental decompression. There were 11 males and 15 females, whose mean age was 51.2 years old ( range; 43-69 years ). T5-8 OLF occurred in 3 cases, T5-9 in 2 cases, T6-9 in 2 cases, T6-11 in 2 cases, T7-10 in 3 cases , T7-1l in 3 cases, T8-11 in 8 cases, T7-12 in 2 cases and T8-L1 in 1 case. The surgical outcomes were evaluated using the improved Japanese Orthopaedic Association ( JOA ) scoring system ( 11 scores ) and the Nurick classiifcation.Results The operation procedures were carried out successfully in all patients. There were 3.7 decompressed segments on average ( range; 3-5 ). The mean operative time was 4.1 hr ( range; 3.0-5.5 hr ). The mean blood loss was 1300 ml ( range; 900-2100 ml ). The postoperative cerebrospinal lfuid leakage occurred in 21 cases. 6 patients had temporarily aggravated spinal cord injuries after the operation. The symptoms of another patient were not obviously improved, but did not get worse. No superficial wound infection was found. All patients were followed up for an average period of 24.4 months ( range; 12-36 months ). The preoperative JOA score was 3.00±2.32 points, which was signiifcantly improved to 7.23±2.18 points at the 2nd week after the operation, and the differences were statistically signiifcant (P<0.05 ). According to the Nurick classiifcation, the results were improved by 3 grades in 9 cases when compared with that preoperatively, 2 grades in 12 cases and 1 grade in 4 cases, with no improvement in 1 patient. The symptoms of all patients did not get worse in the latest follow-up.Conclusions Hemi-articular total laminectomy and segmental decompression is a safe and effective surgical procedure for severe continuous multi-segmental thoracic OLF, with satisfactory clinical results. Special attention should be paid to the surgical techniques.