摘要
目的探讨超声骨刀辅助下"揭盖式"椎管后壁整块切除治疗胸椎黄韧带骨化症(OLF)的临床疗效。方法回顾性分析2015年6月—2017年3月治疗的38例OLF患者的临床资料。根据手术方法分为2组,观察组(21例)行超声骨刀辅助下"揭盖式"椎管后壁整块切除术,对照组(17例)行高速电动磨钻辅助下椎管后壁切除术。记录2组患者手术时间、术中出血量、术前及术后JOA评分,观察是否存在脑脊液漏、神经根及脊髓损伤等并发症以评价临床疗效。结果所有手术均顺利完成,患者随访918(13.6±3.2)个月。观察组手术时间及术中出血量少于对照组,差异有统计学意义(P <0.05);2组患者术后1周及末次随访时日本骨科学会(JOA)评分均较术前改善,差异有统计学意义(P <0.05),但术前、术后1周及末次随访时JOA评分在组间比较差异无统计学意义(P> 0.05);术中未发现神经根或脊髓损伤,观察组3例及对照组2例患者术后出现脑脊液漏,经非手术治疗后痊愈。所有患者未出现术后神经损伤症状加重等情况。术后复查CT确认手术节段脊髓均获得充分减压。结论超声骨刀辅助下"揭盖式"椎管后壁整块切除治疗OLF与高速电动磨钻辅助下椎管后壁切除术疗效相当,且能减少手术时间、降低出血量。
Objective To explore the clinical efficacy of total laminectomy as “cap uncovering” by ultrasonic bone curette in patients with thoracic ossification of the ligamentum flavum(OLF). Methods The clinical data of 38 patients with OLF were retrospectively analyzed from June 2015 to March 2017.According to different surgical methods,38 patients were divided into 2 groups.In the observation group,21 patients underwent total laminectomy as “cap uncovering” by ultrasonic bone curette,while in the control group 17 patients underwent laminectomy with the assistance of high-speed electric drill. Operation time,intraoperative blood loss,and Japanese Orthopaedic Association(JOA) score before and after surgery were recorded in the 2 groups,and the clinical efficacy was evaluated by complications such as cerebrospinal fluid leak,nerve root and spinal cord injury. Results All the operations were successfully completed. The patients were followed up for 9 - 18(13.6±3.2) months. Operation time and intraoperative blood loss in the observation group were less than those in the control group,and the differences were statistically significant(P < 0.05). The JOA score was improved at postoperative 1 week and final follow-up in the 2 groups,and the difference was statistically significant(P < 0.05). However,there was no statistically significant difference in JOA score between the 2 groups at pre-operation,postoperative 1 week and final follow-up(P > 0.05). No nerve root and spinal cord injuries were found during the operation. Three patients in the observation group and 2 in the control group suffered from cerebrospinal fluid leak after operation and recovered after conservative treatment. All the patients had no aggravation of neurological symptoms after operation. CT reexamination confirmed that all operated segments of the spinal cord were fully decompressed. Conclusion Total laminectomy as “cap uncovering” with ultrasonic bone curette for OLF is as effective as highspeed electric drill-assisted laminectomy,and also can reduce operation time and blood loss.
作者
彭祥平
魏运栋
苑乾
李强
吴占勇
PENG Xiang-ping;WEI Yun-dong;YUAN Qian;LI Qiang;WU Zhan-yong(Department of Orthopaedics,Xingtai Mining Group General Hospital,Xingtai 054000,Hebei,China)
出处
《脊柱外科杂志》
2019年第2期105-109,共5页
Journal of Spinal Surgery
关键词
胸椎
黄韧带
骨化
异位性
椎板切除术
超声疗法
Thoracic vertebrae
Ligamentum flavum
Ossification,heterotopic
Laminectomy
Ultrasonic therapy
