椎板分区切除法脊髓减压内固定治疗胸椎黄韧带骨化症的疗效观察

目的探讨椎板分区切除法脊髓减压内固定术在治疗胸椎黄韧带骨化症（thoracic ossification of the ligamentum flavum，T-OLF）的疗效性及安全性。方法回顾性分析58例T-OLF病人的临床资料，根据手术方法将其分为:A组（25例），根据黄韧带的解剖学特点及与椎板的毗邻关系，在椎板后方进行区域划分后，采用椎板分区减压、逐节切除、脊髓减压内固定术治疗；B组（21例），采用椎板分层薄化法减压内固定术治疗。记录2组手术时间、出血量及并发症发生情况，观察术后病人神经功能恢复及局部后凸角变化情况。结果2组手术时间和术中出血量差异均无统计学意义（P>0.05）。2组术后JOA评分均较术前有明显升高（P < 0.05））；A组神经功能改善率（72.2±14.8）%，B组为（73.1±15.2）%，差异无统计学意义（P>0.05）。2组术后局部Cobb角均较术前有明显改善（P < 0.01），不同时间点组间比较差异均无统计学意义（P>0.05）。A组病人脑脊液漏发生率12.00%与B组的23.80%差异有统计学意义（P < 0.05）。结论椎板分区切除法脊髓减压内固定可减少椎管内侵袭性操作，硬膜撕裂的发生率低，安全性相对高，内固定植入有利于术后胸椎稳定性更好维持。

Clinical observation of subsection laminectomy spinal decompression combined with internal fixation in the treatment of thoracic ossification of the ligamentum flavum

ObjectiveTo investigate the clinical efficacy and safety of subsection laminectomy spinal decompression combined with internal fixation in the treatment of thoracic ossification of the ligamentum flavum(T-OLF).MethodsThe clinical data of 58 patients with T-OLF were retrospectively analyzed.According to the surgical method, the patients were divided into the group A(25 cases) and group B(21 cases).According to the anatomical characteristics of ligamentum flavum and its adjacent relationship with the vertebral plate, the posterior region of the vertebral plate was divided, and the vertebral plate decompression, segmental resection and spinal cord decompression were performed in group A.The group B was treated with laminae thinning and decompression combined with internal fixation.The operative time, intraoperative blood loss and complications were recorded, and the recovery of neurological function and change of local kyphosis were observed in two groups.ResultsThe differences of the operative time and blood loss between two groups were not statistically significant(P>0.05), and the JOA scores in two groups significantly increased compared with those before surgery(P < 0.05).The neurological improvement rate in group A and group B was(72.2±14.8)% and(73.1±15.2)%, respectively, and the difference of which was not statistically significant(P>0.05).The Cobb angles in two groups were significantly improved compared with preoperative level(P < 0.01), and there was no statistical significance between two groups at different time points(P>0.05).The difference of the incidence rate of cerebrospinal fluid leakage between group A(12.00%) and group B(23.80%) was statistically significant(P < 0.05).ConclusionsThe subsection laminectomy spinal decompression combined with internal fixation can reduce the invasive operation in the spinal canal, the incidence of dural tear is low, the safety is relatively high, and the internal fixation implantation is beneficial to better maintain the stability of thoracic vertebra after operation.