Background Ossification of the ligamentum flavum （OLF） has been widely recognized as one of the main causes of thoracic spinal canal stenosis and thoracic myelopathy.Decompression is the only effective strategy for ...Background Ossification of the ligamentum flavum （OLF） has been widely recognized as one of the main causes of thoracic spinal canal stenosis and thoracic myelopathy.Decompression is the only effective strategy for treating thoracic myelopathy caused by OLF.The purpose of this study was to describe the clinical outcomes of computer-assisted minimally invasive spine surgery （CAMISS） for posterior decompression in patients with thoracic myelopathy caused by OLF.Methods In all cases,the surgical procedure was performed with the assistance of an intraoperative three-dimensional navigation system.Decompression of the spinal cord was performed with a high-speed drill; the supraspinal ligaments and spinous process were partially preserved.The outcomes were evaluated by a modified Japanese Orthopedic Association （JOA） scoring system and recovery rates.Results The mean duration of follow-up for the 14 cases was 3.9 years.All patients experienced neurological recovery,the mean JOA score improving from 6.1 points preoperatively to 8.6 points at final follow-up and the mean rate of recovery being 52.7% （excellent in two cases,good in eight,fair in three,and unchanged in one）.Conclusion CAMISS is a safe and effective procedure for resection of the OLF in the thoracic spine.展开更多
目的探讨超声骨刀在胸椎黄韧带骨化型胸椎管狭窄症手术应用中的安全性和有效性。方法回顾性分析2012-01-2015-06收治的因胸椎黄韧带骨化(ossification of ligamentum flavum,OLF)致胸椎管狭窄症接受手术患者52例,根据手术方法分为超声...目的探讨超声骨刀在胸椎黄韧带骨化型胸椎管狭窄症手术应用中的安全性和有效性。方法回顾性分析2012-01-2015-06收治的因胸椎黄韧带骨化(ossification of ligamentum flavum,OLF)致胸椎管狭窄症接受手术患者52例,根据手术方法分为超声骨刀组(A组)和高速磨钻组(B组),每组26例。观察两组患者手术情况,治疗效果,术中实时记录胸椎管后壁切除时间、术中出血量、术中有无硬膜囊损伤和脑脊液漏、有无脊髓和神经根损伤。结果 A组出现脑脊液漏5例(19.2%),B组8例(30.8%),两组相比无统计学意义(x^2=0.923,P=0.337);A组神经根损伤1例(3.8%),B组3例(11.5%),两组相比无统计学意义(x^2=0.271,P=0.603)。术后6个月随访时植骨均获得骨性融合,无内固定松动、断裂、移位等并发症。所有患者术后2、6个月和末次随访JOA评分与术前相比,差异有统计学意义(F=169.126,P=0.000),末次随访时总优良率为78.8%。A、B两组术前、术后2个月、6个月和末次随访JOA评分同时间点相比较,差异无统计学意义(P>0.05)。A、B两组患者单个节段胸椎管后壁切除时间分别为3.7±1.0(2~6)min和6.2±2.0(3.5~12)min,差异有统计学意义(t=-5.542,P=0.000);单个节段胸椎管后壁切除的术中出血量分别为107.2±33.0(65~195)ml和163.9±45.5(65~250)ml,差异有统计学意义(t=-4.787,P=0.000)。结论胸椎管后壁切除术治疗胸椎管狭窄症疗效确切,应用超声骨刀可安全、有效地完成胸椎管狭窄症的减压手术操作。与高速磨钻相比,超声骨刀的应用缩短了手术时间,减少了出血量,降低了并发症的发生。展开更多
文摘Background Ossification of the ligamentum flavum （OLF） has been widely recognized as one of the main causes of thoracic spinal canal stenosis and thoracic myelopathy.Decompression is the only effective strategy for treating thoracic myelopathy caused by OLF.The purpose of this study was to describe the clinical outcomes of computer-assisted minimally invasive spine surgery （CAMISS） for posterior decompression in patients with thoracic myelopathy caused by OLF.Methods In all cases,the surgical procedure was performed with the assistance of an intraoperative three-dimensional navigation system.Decompression of the spinal cord was performed with a high-speed drill; the supraspinal ligaments and spinous process were partially preserved.The outcomes were evaluated by a modified Japanese Orthopedic Association （JOA） scoring system and recovery rates.Results The mean duration of follow-up for the 14 cases was 3.9 years.All patients experienced neurological recovery,the mean JOA score improving from 6.1 points preoperatively to 8.6 points at final follow-up and the mean rate of recovery being 52.7% （excellent in two cases,good in eight,fair in three,and unchanged in one）.Conclusion CAMISS is a safe and effective procedure for resection of the OLF in the thoracic spine.
文摘目的探讨超声骨刀在胸椎黄韧带骨化型胸椎管狭窄症手术应用中的安全性和有效性。方法回顾性分析2012-01-2015-06收治的因胸椎黄韧带骨化(ossification of ligamentum flavum,OLF)致胸椎管狭窄症接受手术患者52例,根据手术方法分为超声骨刀组(A组)和高速磨钻组(B组),每组26例。观察两组患者手术情况,治疗效果,术中实时记录胸椎管后壁切除时间、术中出血量、术中有无硬膜囊损伤和脑脊液漏、有无脊髓和神经根损伤。结果 A组出现脑脊液漏5例(19.2%),B组8例(30.8%),两组相比无统计学意义(x^2=0.923,P=0.337);A组神经根损伤1例(3.8%),B组3例(11.5%),两组相比无统计学意义(x^2=0.271,P=0.603)。术后6个月随访时植骨均获得骨性融合,无内固定松动、断裂、移位等并发症。所有患者术后2、6个月和末次随访JOA评分与术前相比,差异有统计学意义(F=169.126,P=0.000),末次随访时总优良率为78.8%。A、B两组术前、术后2个月、6个月和末次随访JOA评分同时间点相比较,差异无统计学意义(P>0.05)。A、B两组患者单个节段胸椎管后壁切除时间分别为3.7±1.0(2~6)min和6.2±2.0(3.5~12)min,差异有统计学意义(t=-5.542,P=0.000);单个节段胸椎管后壁切除的术中出血量分别为107.2±33.0(65~195)ml和163.9±45.5(65~250)ml,差异有统计学意义(t=-4.787,P=0.000)。结论胸椎管后壁切除术治疗胸椎管狭窄症疗效确切,应用超声骨刀可安全、有效地完成胸椎管狭窄症的减压手术操作。与高速磨钻相比,超声骨刀的应用缩短了手术时间,减少了出血量,降低了并发症的发生。
