摘要
目的介绍胸椎椎体前移固定手术技术,探讨其治疗2例后纵韧带骨化性重度胸椎管狭窄患者的手术体会。方法术前行CT、MRI检查,评估患者后纵韧带骨化及胸椎管狭窄程度,采用新术式"胸椎椎体前移固定术"治疗,即通过后入路切除相应骨化节段的胸椎椎板、摘除头侧和尾侧正常/骨化节段之间的椎间盘、切断骨化节段双侧所有肋骨、利用钉棒系统将连续多个胸椎椎体连同骨化的后纵韧带向前推移的方法进行脊髓减压。结果手术过程顺利,术中未出现动静脉、脊髓损伤或脑脊液漏等并发症。术后患者下肢症状明显改善,CT和MRI扫描显示胸椎椎体前移位置及距离满意,椎管明显增宽。结论利用"胸椎椎体前移固定术"治疗后纵韧带骨化性重度胸椎管狭窄安全有效,但目前临床开展例数极少,有待进一步研究。
Objective To introduce a new surgical technique of thoracic column antedisplacement and fixation (TCAF), and to discuss the surgical experiences for 2 cases of serious thoracic spinal stenosis (TSS) with ossification of posterior longitudinal ligament (OPLL) treated by TCAF. Methods CT and MRI were performed preoperatively to evaluate the degrees of stenosis and ossification of these two patients. New procedure TCAF was performed for spinal decompression using screw-rod system to push forward multiple thoracic vertebrae together with the ossified posterior longitudinal ligament, after resecting the relative lamina of ossified segmental thoracic vertebrae, removing the intervertebral disc between normal and ossified segment in cephalic and caudal part, and severing all ribs on both sides of the ossified segment via posterior approach. Results The operation was successful without complications of arteriovenous injury, spinal cord trauma or cerebrospinal fluid leakage. Symptoms in lower limbs were improved obviously after the surgery. Postoperative CT and MRI scan showed good position and satisfactory distance of anterior displacement of the ossified segmental thoracic vertebra, and the vertebral canal was found widened significantly. Conclusion Being a new procedure for the treatment of severe TSS caused by OCLL, TCAF is safe and effective;However, it needs further study because of being performed in very few cases.
作者
马向阳
邹小宝
陈育岳
葛苏
夏虹
吴增晖
王建华
艾福志
章凯
李恒锐
MA Xiangyang;ZOU Xiaobao;CHEN Yuyue;GE Su;XIA Hong;WU Zenghui;WANG Jianhua;AI Fuzhi;ZHANG Kai;LI Hengrui(Department of Spine Surgery,Hospital of Orthopaedics,General Hospital of Southern Theatre Command,Guangzhou,Guangdong 510010,China)
出处
《中国骨科临床与基础研究杂志》
2018年第6期325-331,共7页
Chinese Orthopaedic Journal of Clinical and Basic Research
关键词
胸椎
椎管狭窄
骨化
后纵韧带
脊髓压迫症
减压术
外科
椎体前移固定
椎板切除术
椎间盘切除术
肋骨
Thoracic vertebrae
Spinal stenosis
Ossification of posterior longitudinal ligament
Spinal cord compression
Decompression, surgical
Column antedisplacement and fixation
Laminectomy
Diskectomy
Ribs
