摘要目的 探讨胸椎管后壁切除联合去后凸治疗多节段胸椎后纵韧带骨化症的安全性及疗效.方法 回顾性分析2012年8月至2013年3月采用胸椎管后壁切除联合去后凸术治疗5例多节段胸椎后纵韧带骨化症患者资料,男2例,女3例;年龄45～56岁,平均52岁;术前病程2个月～6年.5例患者均存在多节段胸椎后纵韧带骨化,骨化节段数5～10节;均合并多节段黄韧带骨化,黄韧带骨化节段数为2～10节;后凸Cobb角22°～56°,平均35.8°.术前日本骨科协会(Japanese Orthopaedic Association Scores,JOA)胸脊髓功能评分为3～6分,平均3.8分.计算患者手术时间、出血量,评价术后脊髓功能恢复情况、手术并发症等.结果 5例患者手术时间为5.5～7.0 h,平均6.3 h;出血量为1 500～6 000 ml,平均3 900 ml;切除椎管后壁数为7～12节,平均8.2节.其中2例去后凸节段数为2节,3例去后凸节段数为1节,去后凸度数为2°～15°,平均7.8°.5例患者随访时间21～27个月,术后均发生并发症,并发症发生率为100％.其中4例术后即刻并发脑脊液漏,经常压引流4～5 d及加压包扎24 h治愈,另1例术后次日并发硬膜外血肿形成,遂急诊行血肿清除术.5例患者均获得随访,随访时间21～27个月,平均24个月.末次随访时4例脑脊液漏患者伤口愈合良好,双下肢功能恢复至正常或接近正常;1例硬膜外血肿形成者双下肢功能恢复至正常水平.5例患者末次随访时的JOA胸脊髓功能评分为9～11分,平均10分;改善率为75％～100％,平均85.6％.按照改良Epstein标准评价术后疗效,优4例,良1例,优良率为100％.结论 胸椎管后壁切除联合去后凸治疗多节段胸椎后纵韧带骨化症的疗效满意,但手术时间长、出血量大、并发症发生率高.

abstractsObjective To investigate the safety and efficiency of thoracic laminectomy with dekyphosis for thoracic myelopathy due to multi-segmental ossification of the posterior ligaments.Methods The clinical data of five cases of thoracic myelopathy due to multi-segmental ossification of longitudinal ligaments who were surgically treated in our hospital between August 2012 and March 2013 were retrospectively analyzed,among which two were male and the other three were female,with an average age of 52 (range,45-56) years old.The pre-operative duration ranged from 2 months to 6 years.All five cases were suffering from progressive bilateral partial paraplegia with an average preoperative JOA score 3.8 (range,3-6),an average segment-number of ossification of the posterior ligaments 7.6 (range,5-10),and also an average segment-number of 5.0 (range,2-10) ossification of the ligamentum flavum.All the five cases showed different kyphosis at the stenotic area of thoracic spine,with an average kyphotic angle (Cobb) of 35.8° (range,22°-56°).Their pre-operative Japanese Orthopaedic Association score (JOA) was 3.8 averagely (range,3-6).Clinical features,operation time,blood loss,perioperative complications and postoperative outcome were recorded.Results The segment number of laminectomy of these five cases was 8.2 averagely.The segment number of dekyphosis was 2 for 2 cases and 1 for the other 3 cases,with a average dekyphotic degree of 7.8° (range,2°-15°).The average operation time was 6.3 hours (range,5.5-7.0 hours) and the average blood loss was 3900 ml.The perioperative complications included cerebrospinal fluid leakage in 4 cases who were treated conservatively,and epidural hematoma in 1 case who underwent reoperation for removing the hematoma.All cases were followed up for 21 to 27 months,and their average final JOA score was 10,with an average recovery rate of 85.6％,and a rate of excellent or good was 100％ by the modified Epstein standard.Conclusion The result of thoracic laminectomy combined with dekyphosis for thoracic myelopathy due to multi-segmental ossification of longitudinal ligaments is quite satisfying,however this procedure is demanding with a long operation time,a huge blood loss and a high complication rate.