经关节突入路减压固定治疗多节段黄韧带骨化型胸椎管狭窄症的效果(1)
[摘要] 目的 探討经关节突入路治疗多节段黄韧带骨化型(MSOLF型)胸椎管狭窄症的效果。 方法 回顾性分析2008年1月～2014年12月西安交通大学第二附属医院经关节突入路治疗的MSOLF型胸椎管狭窄症患者26例。采用改良的JOA评分评估术后效果，记录术前、术后1周和末次随访时的Frankel分级，测量手术节段后凸Cobb角，观察术中术后并发症。 结果 手术均在诱发电位监护下完成，手术时间2.7～5.2 h，平均(4.1±1.2)h；出血量650～2900 mL，平均(1940±824)mL。2例患者术中诱发电位波形异常，4例发生脑脊液漏，1例发生气胸。随访24～96个月，平均(4.0±4.8)个月。末次随访Frankel分级C级6例，D级8例，E级12例。JOA评分末次随访较术前明显提高，差异有统计学意义(P < 0.05)，改善率为70.3%；植骨融合率100%，无内固定失败病例；Cobb角末次随访与术后1周比较，差异无统计学意义(P > 0.05)。 结论 经后路关节突减压椎弓根螺钉固定治疗MSOLF型胸椎管狭窄症减压充分，并发症少，临床效果良好。术中脊髓诱发电位监护灵敏度高，能够提高术中操作安全性。采用引流1周缝合管口的方法可有效控制脑脊液漏。
[关键词] 胸椎；椎管狭窄；黄韧带骨化；经关节突入路；临床疗效
[中图分类号] R687.3 [文献标识码] A [文章编号] 1673-7210(2017)03(c)-0086-04
Effect of transfacet approach decompression and internal fixation for thoracic spinal stenosis caused by multi-segmental ossification of ligamentumflavum
ZANG Quanjin LIANG Hui YANG Pinglin LI Haopeng HE Xijing
Department of Orthopaedics， Second Affiliated Hospital of Xi'an Jiaotong University， Shaanxi Province， Xi'an 710004， China.
[Abstract] Objective To evaluate the clinical effect of transarticular approach in treating thoracic spinal stenosis caused by multi-segmental ossification of ligamentumflavum (MSOLF). Methods From January 2008 to December 2014， in Second Affiliated Hospital of Xi'an Jiaotong University， the clinical data of 26 MSOLF patients with thoracic spinal stenosis were retrospective analyzed. Postoperative neurological status was evaluated by the modified JOA score system. The Frankel grade and Cobb angle of kyphosis were measured at postoperative 1 week and final followed up respectively， the complications during and after operation were recorded. Results All operations were performed under theuse of spinal cord evoked potential (SEP) monitoring. The operation time was 2.7-5.2 h， mean was (4.1±1.2) h and bleeding volume was 650-2900 mL， mean was (1940±824) mL. 2 patients had abnormalitiesin intraoperative monitoring in SEP， 4 cases suffered cerebrospinal fluid leakage， 1 case suffered pneumothorax. The follow-up time was 24-96 months， mean was (40.0±4.8) months. At final follow-up： 6 cases were grade C， 8 cases were grade D， 12 cases were grade E. JOA at final follow-up improved than before operation， the difference was statistically significant (P < 0.05)， improvement rate was 70.3%； the bone graft fusion rate was 100%， there was no internal fixation failure； the Cobb angle at postoperative 1 week compared with final follow-up， the difference was not statistically significant (P > 0.05). Conclusion Treating MSOLF thoracic spinal stenosis through transarticular approach with pedicle screws can decompress the spinal cord completely， the complications are few， the clinical outcomes are favorite. Intraoperative SEP monitoringis of high sensitivity， it can improve the safety of intraoperative manipulatation. The method of persistent drainage for 1 week followed by the close the sinus of drainage tubeis can effectively treat cerebrospinal fluid leakage., 百拇医药(臧全金 梁辉 杨平林 李浩鹏 贺西京)
[关键词] 胸椎；椎管狭窄；黄韧带骨化；经关节突入路；临床疗效
[中图分类号] R687.3 [文献标识码] A [文章编号] 1673-7210(2017)03(c)-0086-04
Effect of transfacet approach decompression and internal fixation for thoracic spinal stenosis caused by multi-segmental ossification of ligamentumflavum
ZANG Quanjin LIANG Hui YANG Pinglin LI Haopeng HE Xijing
Department of Orthopaedics， Second Affiliated Hospital of Xi'an Jiaotong University， Shaanxi Province， Xi'an 710004， China.
[Abstract] Objective To evaluate the clinical effect of transarticular approach in treating thoracic spinal stenosis caused by multi-segmental ossification of ligamentumflavum (MSOLF). Methods From January 2008 to December 2014， in Second Affiliated Hospital of Xi'an Jiaotong University， the clinical data of 26 MSOLF patients with thoracic spinal stenosis were retrospective analyzed. Postoperative neurological status was evaluated by the modified JOA score system. The Frankel grade and Cobb angle of kyphosis were measured at postoperative 1 week and final followed up respectively， the complications during and after operation were recorded. Results All operations were performed under theuse of spinal cord evoked potential (SEP) monitoring. The operation time was 2.7-5.2 h， mean was (4.1±1.2) h and bleeding volume was 650-2900 mL， mean was (1940±824) mL. 2 patients had abnormalitiesin intraoperative monitoring in SEP， 4 cases suffered cerebrospinal fluid leakage， 1 case suffered pneumothorax. The follow-up time was 24-96 months， mean was (40.0±4.8) months. At final follow-up： 6 cases were grade C， 8 cases were grade D， 12 cases were grade E. JOA at final follow-up improved than before operation， the difference was statistically significant (P < 0.05)， improvement rate was 70.3%； the bone graft fusion rate was 100%， there was no internal fixation failure； the Cobb angle at postoperative 1 week compared with final follow-up， the difference was not statistically significant (P > 0.05). Conclusion Treating MSOLF thoracic spinal stenosis through transarticular approach with pedicle screws can decompress the spinal cord completely， the complications are few， the clinical outcomes are favorite. Intraoperative SEP monitoringis of high sensitivity， it can improve the safety of intraoperative manipulatation. The method of persistent drainage for 1 week followed by the close the sinus of drainage tubeis can effectively treat cerebrospinal fluid leakage., 百拇医药(臧全金 梁辉 杨平林 李浩鹏 贺西京)