摘要
目的描述骨化黄韧带的形态及根黄通道的结构，探讨利用根黄通道后壁减压治疗黄韧带骨化合并胸椎脊髓病的可行性。方法2002年1月至2006年1月手术治疗胸椎黄韧带骨化合并脊髓病74例，男45例，女29例；年龄31-73岁，平均51．9岁。所有患者以CT仿真内窥镜及三维同步定位像观察椎管内骨化黄韧带的形态，确定根黄通道的结构、测量根黄通道的最小横径。采用层揭薄化法，将减压器械伸入到根黄通道内游离、孤立骨化组织进行减压。用JOA括约肌功能评分和下肢运动功能评分以及运动功能恢复率评估疗效。结果CT三维重建下，骨化黄韧带呈“独轮车”样结构。“车体”的终止部和“车柄”分别形成上、下根黄通道的上壁；根黄通道的两侧壁分别为骨化黄韧带和椎弓根；外口为椎间孔，内口与椎管相通。下根黄通道最狭窄处宽度为（1．9±0．93）mm。术中见根黄通道的下壁被硬膜封闭，通道内无硬膜填充。全部病例随访时间3-24个月，平均12．5个月。感觉障碍及下肢麻木疼痛完全恢复56例，部分恢复15例。术后括约肌功能JOA评分为（2．599±0．493）分，与术前比较差异有统计学意义（t=17．19，P〈0．01）；术后运动JOA评分为（3．716±0．702）分，与术前比较差异有统计学意义（t=21．84，P〈0．01），恢复率平均为89．7％。疗效优良率为95．9％。结论上、下根黄通道上壁是骨化黄韧带组织与生理骨性结构间的连接点。根黄通道内空虚，器械进入根黄通道切断其上壁，孤立、游离骨化组织是相对安全、便捷的减压方法。
Objective To describe the configuration of pedicel-ossified ligament flavum tunnel （PFT） and ligament flavum ossification（OLF） in thoracic spine, further to introduce and evaluate the methods of posterior decompression by dissecting pedicle flavum tunnel （PFT）. Methods Seventy-four patients were diagnosed as thoracic spine ligament flavum ossification and there were 45 male and 29 female with an average age of 51.9 years （31-73）. The CT virtual endoscope （CTVE） and muhiplanar co-localization were employed to detect the configuration and connection structures of OLF and to define the construction and the width of PFT. The laminar shelling decompression technique was modified by PFT dissecting in all cases. The JOA lower limb motor function standard and sphincter function standard were used to evaluate the ability of lower limb motion and sphincter function respectively. Results OLF shaped like a barrow, the end of the cart and the hand-shaft of the barrow were the roof of the upper PFT and the lower PFT respectively. The weith of the lower PFT was 1.9±0.93 mm. Once the spinal cannel was opened, the PFT could be observed and there were no dura in it. The mean follow up duration was 12.5 months （3-24 mmonths）. Among 71 sensation disturbance 56 totally recovered, 15 relived. Postoperative JOA sphincter function score was 2.559±0.493, compare with the preoperation score, the difference was siguificant（t=17.19, P〈0.01 ）. Postoperative JOA motor function score was 3.716±0.702, the difference was significant （t=21.84, P〈0.01 ）. Motor function recovery rate was 89.66%, excellent and good rate was 95.9%. Conclusion The roof of the upper and the lower PFT were the bony support of the OLF. Dissecting the roof of PFT was a relative safe and convenient way by which the OLF was be isolated or floated and finally the OLF was be removed.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2007年第1期10-14,共5页
Chinese Journal of Orthopaedics
关键词
胸椎
椎管狭窄
黄韧带
脊髓压迫症
Thoracic vertebrae
Spinal stenosis
Ligamentum flavum
Spinal cord compression
