摘要
目的探讨经胸骨前入路行后纵韧带骨化块切除减压内固定术治疗上胸椎后纵韧带骨化症(OPLL)的远期效果。方法回顾性分析2010-01—2018-01漯河市中心医院骨科收治的17例上胸椎OPLL患者的临床资料。男9例,女8例;年龄37~67岁,平均51.8岁;胸脊髓功能(JOA)评分3~7分。病变节段T_(1~3)。采用经胸骨前入路行后纵韧带骨化块切除减压内固定术。记录术中情况、术后临床指标。术后平均随访64.7个月(24~121个月),评价随访期间的疗效。结果17例均顺利完成手术,2例术中出现心跳缓慢,去除拉钩解除压迫后恢复正常。手术平均时间158.6 min(130~190 min),术中平均出血量560.6 mL(300~800 mL)。3例发生脑脊液漏,未发生纵隔液体潴留引起的并发症。全部患者术后3~17个月恢复正常生活及从事体力劳动。末次随访JOA评分由术前平均5.4分增加到9.9分,术后JOA评分平均改善率80.4%(62.5%~100.0%);胸椎X线片及MRI均显示脊髓减压满意,植骨均获骨性融合。结论切开胸骨的前入路可有效显露T_(1~4)范围,能切除T_(1~3)后纵韧带骨化块,满足内固定操作;而且保留了脊柱后柱结构,远期疗效优良,是治疗上胸椎OPLL的理想术式。
Objective To investigate the long-term effect of trans-sternal approach in the treatment of ossification of posterior longitudinal ligament(OPLL)of upper thoracic ossification.Methods The clinical data of 17 patients with OPLL treated in the Department of orthopedics of Luohe Central Hospital from January of 2010 to January of 2018 were analyzed retrospectively.There were 9 males and 8 females,the age ranged from 37 to 67 years,with an average of 51.8 years.The thoracic spinal cord function(JOA)score was 3~7.The lesion segments were T_(1-3).We conducted resection,decompression and internal fixation of ossification of posterior longitudinal ligament via trans-sternal approach.The intraoperative and postoperative clinical indexes were recorded.The average follow-up was 64.7 months(24~121 months)after operation.Results All 17 cases completed the operation successfully,and 2 cases happened slow heartbeat during the operation.They returned to normal after removing the retractor and relieving the compression.The operation time was 158.6 min(130~190 min),and the volume of blood loss during operation was 560.6 mL(300~800 mL).There were 3 cases complicated with cerebrospinal fluid leakage.No complications occurred due to mediastinal fluid retention.All patients recovered to normal life and engaged in physical labor 3~17 months after operation.In the last follow-up,the average JOA score increased from 5.4 to 9.9.The improvement rate of JOA score after operation was 80.4%(62.5%~100.0%).Thoracic X-ray view and MRI showed satisfactory decompression of spinal cord and bone fusion of bone graft.Conclusion Trans-sternal approach can effectively expose the range of T_(1-4),remove the ossification of posterior longitudinal ligament of T_(1-3),and meet the operation of internal fixation.Moreover,the posterior column structure of the spine is retained,and the long-term effect is excellent.It is an ideal operation for the treatment of OPLL of the upper thoracic spine.
作者
王海蛟
张冠锋
李玉伟
Wang Haijiao;Zhang Guanfeng;Li Yuwei(Luohe Orthopedics of Henan Luohe Municipal Central Hospital,462000 China;Luohe 462000,Luohe Municipal Hospital of Traditional Chinese Medicine,462000 China)
出处
《河南外科学杂志》
2021年第6期33-37,共5页
Henan Journal of Surgery
基金
河南省医学科技攻关项目(LHGJ20191424)。
关键词
上胸椎
前入路
椎管狭窄
后纵韧带骨化症
Upper thoracic spine
Trans-sternal approach
Spinal stenosis
Ossification of posterior longitudinal ligament
