Surgical strategies for ossified ligamentum flavum associated with dural ossification in thoracic spinal stenosis
Surgical strategies for ossified ligamentum flavum associated with dural ossification in thoracic spinal stenosis
复制标题
胸椎管狭窄症合并硬脑膜骨化的黄韧带骨化的手术策略
DOI：
10.1016/j.jocn.2014.02.027
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发表时间：
2014-12-01
影响因子：
2
通讯作者：
Feng, Shiqing
中科院分区：
文献类型：
--
作者：
Sun, Jingcheng;Zhang, Chao;Feng, Shiqing
我们描述了两种治疗胸椎管狭窄症（TSS）合并黄韧带骨化（OLF）和硬脊膜骨化（DO）的手术策略，并讨论了其术后疗效。2004年1月至2008年6月，147例患者接受TSS手术。本研究纳入了33例术中有OLF和DO证据的患者。根据术中硬脑膜处理的不同，将33例患者分为两组：A组17例，切开硬脑膜并切除骨化; B组16例，用钻头将骨化的硬脑膜变薄并浮起。所有患者均接受门诊随访。评价术前和术后日本骨科协会（乔亚）评分和恢复率。平均随访时间为42个月。TSS中DO合并OLF的发生率为22%。1年随访时，A组的平均乔亚评分从5.12 +/- 1.17改善至6.94 +/- 0.90，B组从5.25 +/- 1.34改善至7.13 +/- 1.41。此外，TSS伴DO患者的平均乔亚评分从5.18 ± 1.24改善至7.03 ± 1.16，TSS不伴DO患者的平均JOA评分从5.52 ± 1.21改善至7.21 ± 1.18。狭窄水平的术前和术后硬膜囊横截面积增加表明减压完成。两种减压方法对OLF和DO治疗TSS都是可行的。切开硬脊膜切除骨化硬脊膜和黄韧带以松弛脊髓是一种安全可靠的方法。DO虽然增加了手术难度和风险，但不影响术后神经功能恢复。(C)2014爱思唯尔有限公司版权所有。
We describe two surgical strategies for treating thoracic spinal stenosis (TSS) with ossification of the ligamentum flavum (OLF) and dural ossification (DO), and discuss their postoperative efficacy. From January 2004 to June 2008, 147 patients underwent TSS surgery. Thirty three of those with intraoperative evidence of OLF and DO were included in the present study. Based on the different intraoperative treatment of the dura, these 33 patients were divided into two groups: Group A, 17 patients who had their dura slit and the ossification excised, and Group B, 16 patients treated by floating the ossified dura by thinning it with a drill. All patients underwent outpatient follow-up. Pre- and postoperative Japanese Orthopaedic Association (JOA) scores and recovery rates were evaluated. The mean follow-up period was 42 months. The incidence of DO with OLF in TSS was 22%. At 1 year follow-up, the mean JOA score improved from 5.12 +/- 1.17 to 6.94 +/- 0.90 in Group A and from 5.25 +/- 1.34 to 7.13 +/- 1.41 in Group B. Additionally, the mean JOA score improved from 5.18 +/- 1.24 to 7.03 +/- 1.16 in TSS patients with DO and from 5.52 +/- 1.21 to 7.21 +/- 1.18 in TSS patients without DO. The increased cross-sectional area of the pre- and postoperative dural sac at the level of stenosis suggested that decompression was complete. Both decompression methods are feasible for curing TSS with OLF and DO. Moreover, slitting the dura for ossified dura and ligamentum flavum removal to relax the spinal cord is a safe and reliable method. Even though it increased the surgical difficulties and risks, DO did not affect postoperative neurological recovery. (C) 2014 Elsevier Ltd. All rights reserved.