经皮微通道显微镜下治疗局灶性胸椎黄韧带骨化症Microsurgical resection of focal ossification of thoracic ligamentum flavum through percutaneous microchannel
李锋;刘启峰;陈春美;王锐;石松生;
摘要(Abstract):
[目的]探讨经皮微通道显微镜下治疗局灶性胸椎黄韧带骨化症的安全性及临床疗效。[方法]回顾性分析2014年6月~2016年1月采用经皮微通道显微镜下治疗6例局灶性胸椎黄韧带骨化症患者资料。所有患者均采取气管内插管全麻,俯卧位,腹部悬空,C型臂X线机下"精准定位"。于病灶对应的位置旁开后正中线2.0~2.5cm置入自行研制的脊柱旁正中"锁孔"入路工作管道系统,椎旁扩张套管循克氏针逐级钝性分离肌层,最适宜的手术通道是内径1.42 cm,并沿扩张套管外围置入。通道经蛇形链条连接固定棒,固定于床旁,C型臂X线机再次定位确认通道位于骨化黄韧带后上方。通过手术微创套管高清显微镜下,结合显微高速磨钻及枪状显微器械手术切除责任骨化黄韧带。[结果]手术时间75~120 min;术中出血量25~55 ml;术后3 d后即可下地活动,住院时间6~10 d。随访时间10~24个月,术后均未发生脑脊液漏、硬膜外血肿、截瘫等严重并发症。末次随访时患者双下肢功能恢复至正常或接近正常,JOA胸脊髓功能评分改善率为100%。按照改良Epstein标准评价术后疗效,优良率为100%。[结论]经皮微通道显微镜下治疗局灶性胸椎黄韧带骨化症疗效满意,手术时间短、手术创伤小、出血量少、并发症发生率低。
关键词(KeyWords): 胸椎;椎管狭窄;黄韧带骨化;微创;经皮微通道
基金项目(Foundation):
作者(Author): 李锋;刘启峰;陈春美;王锐;石松生;
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参考文献(References):
- [1]Inamasu J,Guiot BH,Sachs DC.Ossification of the posterior longitudinal ligament:an update on its biology,epidemiology and natural history[J].Neurosurgery,2006,58(6):1027-1039.
- [2]李危石,陈仲强,曾岩,等.胸椎后纵韧带骨化的临床特点及治疗策略[J].中华骨科杂志,2007,27(1):15-18.
- [3]Hou X,Sun C,Liu X,et al.Clinical features of thoracic spinal stenosis-associated myelopathy:a retrospective analysis of 427 cases[J].J Spinal Disord Tech,2014,26.
- [4]刘立成,张佐伦,于锡欣,等.胸椎黄韧带骨化症[J].中国矫形外科杂志,2002,9(1):5-7.
- [5]陈春美,蔡刚峰,张伟强,等.椎旁套管入路与后正中入路显微外科治疗腰椎间盘突出症的疗效比较[J].中华神经外科杂志,2014,30(7):677-681.
- [6]陈春美,蔡刚峰,王锐,等.经皮套管椎旁入路显微切除腰椎椎管内肿瘤[J].中华医学杂志,2015,95(13):969-972.
- [7]陈仲强,党耕町,刘晓光,等.胸椎黄韧带骨化症的治疗方法选择[J].中华骨科杂志,1999,19(4):197-200.
- [8]Hirabayashi K,Miyakawa J,Satomi K,et al.Operative results and postoperative progression of ossification among patients with ossifieation of cervical posterior longitudinal ligament[J].Spine(Phila Pa 1976),1981,6(4):354-364.
- [9]Van Oostenbrugge RJ,Herpers MJ,de Kruijk JR.Spinal cord compression caused by unusual location and extension of ossified ligamenta flava in a Caucasian male.A case report and literature review[J].Spine﹙Phila Pa 1976﹚,1999,24﹙5﹚:486-488.
- [10]王全平,李明全,李新奎,等.胸椎黄韧带骨化[J].中华骨科杂志,1996.16(7):447-450.
- [11]魏富鑫,崔尚斌,刘少喻,等.局灶性胸椎黄韧带骨化症的诊治效果分析[J].脊柱外科杂志,2012,10(4):211-214.
- [12]Nomura H,Yanagisawa Y,Arima J,et al.Clinical outcome of microscopic lumbar spinous process-splitting laminectomy:clinical article[J].J Neurosurg Spine,2014,21(2):187-94.
- [13]Kleiner JB.Spinal distraction instrument[P].US Patent D656.610.2012.
- [14]Righesso O,Falavigna A,Avanzi O.Comparison of open discectomy with microendoscopic discectomy in lumbar disc herniations:results of a randomized controlled trial[J].Neurosurgery,2007,61(3):545-549.