选择治疗后纵韧带骨化症所致胸段脊髓病的手术方法。
Selecting a surgical method for thoracic myelopathy caused by ossification of the posterior longitudinal ligament.
作者信息
Kurosa Y, Yamaura I, Nakai O, Shinomiya K
机构信息
Department of Orthopaedic Surgery, Kudanzaka Hospital, Tokyo, Japan.
出版信息
Spine (Phila Pa 1976). 1996 Jun 15;21(12):1458-66. doi: 10.1097/00007632-199606150-00012.
STUDY DESIGN
The authors classified typical distributional patterns of ossification of the posterior longitudinal ligament of the thoracic spine in 1) central part of S-curve, 2) just above apical vertebra, and 3) combined with ossification of ligamentum flavum below apical vertebra. The results of the surgical methods selected according to the authors' classification were compared with those of previous reports.
OBJECTIVES
To establish the criteria for selecting an appropriate surgical method for ossification of the posterior longitudinal ligament of the thoracic spine.
SUMMARY OF BACKGROUND DATA
Poor surgical results for ossification of the posterior longitudinal ligament of "middle or lower thoracic spine" have been reported, but the unsuccessful location and curve has not been strictly defined.
METHODS
The authors studied postsurgical results in 26 cases of thoracic myelopathy caused by ossification of the posterior longitudinal ligament. They also investigated radiographs of 111 cases, including 85 patients under observation, and examined the relationships between thoracic spine alignment and ossification of the posterior longitudinal ligament distribution.
RESULTS
Twenty-three patients treated with methods conforming to the authors' criteria achieved satisfactory recovery in walking ability except for one patient. The results of the other three patients who underwent surgery with nonconforming methods were uneven.
CONCLUSION
Posterior decompression, as well as anterior decompression, is effective in the first pattern in the cervicothoracic region. In case of the second pattern, the responsible ossification of the posterior longitudinal ligament always lies one or two levels above the apical vertebra and should be removed by anterior approach, regardless of the extent of kyphosis. Transthoracic anterior decompression surgery is considered the best method for most patients under the second and third patterns.
研究设计
作者将胸椎后纵韧带骨化的典型分布模式分为1）S形曲线的中央部分，2）顶椎上方，3）与顶椎下方的黄韧带骨化合并。将根据作者分类选择的手术方法的结果与先前报告的结果进行比较。
目的
建立选择合适的胸椎后纵韧带骨化手术方法的标准。
背景数据总结
已有报道称“中下段胸椎”后纵韧带骨化的手术效果不佳，但未成功的部位和曲线尚未严格界定。
方法
作者研究了26例由后纵韧带骨化引起的胸椎脊髓病的术后结果。他们还调查了111例患者的X线片，包括85例观察中的患者，并检查了胸椎排列与后纵韧带骨化分布之间的关系。
结果
23例采用符合作者标准方法治疗的患者，除1例患者外，行走能力均恢复良好。另外3例采用不符合标准方法手术的患者结果参差不齐。
结论
后路减压以及前路减压在颈胸段的第一种模式中是有效的。对于第二种模式，后纵韧带的责任骨化总是位于顶椎上方一或两个节段，无论后凸程度如何，均应采用前路手术切除。对于大多数处于第二种和第三种模式的患者，经胸前路减压手术被认为是最佳方法。
Zotero 插件