Zhang Z H, Wang Q D, Wang Z W, Jiang W T, Liu P L, Kang Y S, Su K, Mei W
Department of Spinal Surgery,Zhengzhou Orthopaedic Hospital,Zhengzhou 450052,China.
Zhonghua Wai Ke Za Zhi. 2021 Nov 1;59(11):940-946. doi: 10.3760/cma.j.cn112139-20210510-00207.
To investigate the safety and clinical efficacy of "zoning" style laminectomy by ultrasonic bone curette in patients with severe thoracic ossification of the ligamentum flavum(TOLF). The clinical data of 36 patients with severe TOLF treated by "zoning" style laminectomy at Department of Spinal Surgery,Zhengzhou Orthopaedic Hospital from October 2015 to October 2018 were respectively analyzed.There were 17 males and 19 females,aged(57.3±10.2)years(range:43 to 80 years).According to the anatomical characteristics of the thoracic ligamentum flavum and the pathological process of ossionization,each decompression segment was divided into the upper 1/3 area of the lamina,the bilateral area of the ossionum flavum,the transitional area,and the area of close contact between the ossionum flavum and the spinal cord.Different surgical strategies were used for decompression in turn.The modified Japanese Orthopedic Association (mJOA) was used to evaluate the neurological function status before and after surgery,to evaluate the surgical effect of patients,and to observe the surgical complications.Paired sample T test was used for data analysis. All 36 patients successfully completed the operation,the operation time was (88.6±24.6) minutes(range:60 to 150 minutes).The intraoperative blood loss was (426.7±167.4) ml(range:250 to 800 ml).Follow-up time was (27.2±7.7) months(range:12 to 48 months).The mJOA score at the last follow-up was 9.0±1.5,which was statistically significant compared with the preoperative score 5.4±1.8 (=13.59,<0.01).The improvement rate of mJOA score was (65.7±22.1) %,of which 17 cases were excellent (47.2%),13 cases were good (36.1%),4 cases were normal (11.1%),2 cases were ineffective (5.6%).Ten patients had cerebrospinal fluid leakage during the separation or removal of dural ossification and were cured after a series of comprehensive conservative treatment.Two patients showed transient neurological deterioration,and the neurological function gradually recovered to the preoperative state after comprehensive treatment such as increasing the mean arterial pressure and using neurotrophic drugs.During the follow-up,no aggravation of neurological dysfunction and segmental kyphosis were found. The ultrasonic bone curette-assisted "zoning" style laminectomy for the treatment of severe TOLF can directly observed the position relationship between ossification of the ligamentum flavum and the spinal canal structure during the operation,and accurately guide the surgical decompression.It has the advantages of safe operation and complete decompression,which provides an important reference for the selection of clinical surgery.
探讨超声骨刀“分区”式椎板切除术治疗重度胸段黄韧带骨化症（TOLF）患者的安全性及临床疗效。回顾性分析2015年10月至2018年10月在郑州市骨科医院脊柱外科采用“分区”式椎板切除术治疗的36例重度TOLF患者的临床资料。其中男17例，女19例，年龄（57.3±10.2）岁（范围：43至80岁）。根据胸段黄韧带的解剖特点及骨化病理进程，将每个减压节段分为椎板上1/3区域、黄韧带双侧区域、移行区域以及黄韧带与脊髓紧密接触区域，依次采用不同手术策略进行减压。采用改良日本骨科学会（mJOA）评分评估手术前后神经功能状态，评价患者手术效果，并观察手术并发症。采用配对样本T检验进行数据分析。36例患者均顺利完成手术，手术时间为（88.6±24.6）分钟（范围：60至150分钟），术中出血量为（426.7±167.4）毫升（范围：250至800毫升）。随访时间为（27.2±7.7）个月（范围：12至48个月）。末次随访时mJOA评分为9.0±1.5，与术前评分5.4±1.8比较差异有统计学意义（t = 13.59，P <0.01）。mJOA评分改善率为（65.7±22.1）%，其中优17例（47.2%），良13例（36.1%），正常4例（11.1%），无效2例（5.6%）。10例患者在分离或切除硬膜骨化时出现脑脊液漏，经一系列综合保守治疗后治愈。2例患者出现短暂性神经功能恶化，经提高平均动脉压及使用神经营养药物等综合治疗后神经功能逐渐恢复至术前状态。随访期间未发现神经功能障碍及节段性后凸加重。超声骨刀辅助“分区”式椎板切除术治疗重度TOLF，术中可直接观察黄韧带骨化与椎管结构的位置关系，准确指导手术减压，具有手术安全、减压彻底等优点，为临床手术选择提供了重要参考。
