经皮脊柱内镜治疗胸椎黄韧带骨化症的临床研究
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摘要
目的探讨经皮脊柱内镜治疗局灶型胸椎黄韧带骨化症(ossification of ligamentum flavum,OLF)的手术疗效。方法对2015年6月至2017年5月,我科采用经皮脊柱内镜治疗的32例胸椎OLF患者的临床资料进行回顾性分析,记录手术时间、术中出血量、住院时间、疼痛视觉模拟评分(visual analogue scale,VAS)和日本骨科协会(Japanese orthopaedic association,JOA)评分等指标并进行统计分析。结果本组手术时间为(101.04±29.36) min,术中出血量(24±12.41) ml,住院时间(11.8±5.18)天,VAS评分由术前(7.89±1.07)分降至术后1天(3.81±0.57)分,12个月随访的(1.51±0.57)分,显著低于术前,差异有统计学意义(P<0.05),疼痛缓解明显;JOA评分由术前(12.63±1.31)分升至术后1天(17.81±1.18)分,12个月随访的(25.63±1.31)分,显著高于术前,差异有统计学意义(P<0.05),JOA平均改善率(79.85±6.32)%;病程≤12个月患者JOA改善率与病程>12个月患者相比较差异有统计学意义(P<0.05),术前JOA评分≤12的患者JOA改善率显著高于JOA评分>12的患者,差异有统计学意义(P<0.05)。术后12个月32例恢复情况:优22例,良6例,可4例,优良率为87.50%。结论经皮脊柱内镜治疗局灶型胸椎OLF患者疗效显著,手术创伤小,术中出血少,术后恢复快,并发症少,是临床上值得探索与研究的、新的、有效的微创手术方式。
Objective To investigate the curative effects and influencing factors of ossification of ligamentum flavum (OLF) treated by percutaneous spinal endoscopy. Methods A total of 32 patients with ossification of ligamentum flavum (OLF), from June 2015 to May 2017, were retrospectively analyzed. To observe, record and statistically analyze the operation time, bleeding amount, hospital stay, visual analogue scale (VAS), and the Japan Orthopaedic Association (JOA) scores. Results Operation time was (101.04 ± 29.36) min, intraoperative hemorrhage (24 ± 12.41) ml, hospital stay (11.8 ± 5.18) d. The VAS score was reduced from pre-operative (7.89 ± 1.07) to 1 day (3.81 ± 0.57) after surgery. The 12-month follow-up (1.51 ± 0.57) was significantly lower than that preoperatively (P < 0.05), and pain relief was significant. The JOA was increased from preoperative (12.63 ± 1.31) to 1 day (17.81 ± 1.18) after surgery, and the 12-month follow-up (25.63 ± 1.31) was significantly higher than that preoperatively (P < 0.05). JOA average improvement rate was (79.85 ± 6.32), showing significant differences between the JOA improvement rate in 12 months' patients and the duration > 12 months' patients (P < 0.05). JOA improvement rate in preoperative patients with JOA score ≤ 11 was significantly higher than that of the control group (P < 0.05). After 12 months, 32 patients recovered: 22 excellent cases, 6 good cases, 4 general case, excellent rate of 87.50%. The average improvement rate of JOA in the 12 months after surgery reached 79.85%. ConclusionsPercutaneous spinal endoscopy is effective for patients with ossification of ligamentum flavum (OLF) of the thoracic vertebrae. The operation is less invasive with less bleeding, less complication, and quick recovery. It is really a new and effective method that is worth exploring and researching.
Objective To investigate the curative effects and influencing factors of ossification of ligamentum flavum (OLF) treated by percutaneous spinal endoscopy. Methods A total of 32 patients with ossification of ligamentum flavum (OLF), from June 2015 to May 2017, were retrospectively analyzed. To observe, record and statistically analyze the operation time, bleeding amount, hospital stay, visual analogue scale (VAS), and the Japan Orthopaedic Association (JOA) scores. Results Operation time was (101.04 ± 29.36) min, intraoperative hemorrhage (24 ± 12.41) ml, hospital stay (11.8 ± 5.18) d. The VAS score was reduced from pre-operative (7.89 ± 1.07) to 1 day (3.81 ± 0.57) after surgery. The 12-month follow-up (1.51 ± 0.57) was significantly lower than that preoperatively (P < 0.05), and pain relief was significant. The JOA was increased from preoperative (12.63 ± 1.31) to 1 day (17.81 ± 1.18) after surgery, and the 12-month follow-up (25.63 ± 1.31) was significantly higher than that preoperatively (P < 0.05). JOA average improvement rate was (79.85 ± 6.32), showing significant differences between the JOA improvement rate in 12 months' patients and the duration > 12 months' patients (P < 0.05). JOA improvement rate in preoperative patients with JOA score ≤ 11 was significantly higher than that of the control group (P < 0.05). After 12 months, 32 patients recovered: 22 excellent cases, 6 good cases, 4 general case, excellent rate of 87.50%. The average improvement rate of JOA in the 12 months after surgery reached 79.85%. ConclusionsPercutaneous spinal endoscopy is effective for patients with ossification of ligamentum flavum (OLF) of the thoracic vertebrae. The operation is less invasive with less bleeding, less complication, and quick recovery. It is really a new and effective method that is worth exploring and researching.
引文
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[15]Jang JS,An SH,Lee SH.Transforaminal percutaneous endoscopic discectomy in the treatment of foraminal and extraforaminal lumber disc herniations[J].J Spinal Disord Tech,2006,19(5):338-343.
[16]陈会平.经皮微通道显微镜手术治疗局灶性胸椎黄韧带的疗效观察及其影响因素分析[J].颈腰痛杂志,2018,39(1):5-8.
[17]Ahn Y,Lee HY,Lee SH,et al.Dural tears in percutaneous endoscopic lumbar discectomy[J].Eur Spine J,2011,20(1):58-64.
[18]Oppenheimer JH,DeCastro I,McDonnell DE.Minimally invasive spine technology and minimally invasive spine surgery:a historical review[J].Neurosurg Focus,2009,27(3):E9.
[19]Guo JJ,Luk KD,Karppinen J,et al.Prevalence,distribution,and morphology of ossification of the ligamentum flavum:a population study of one thousand seven hundred thirty-six magnetic resonance imaging scans[J].Spine,2010,35(1):51-56.
[20]Chen ZQ,Sun CG.Spine Surgery Group of Chinese Orthopedic Association.Clinical for treatment of sympotomatic thoracic spinal tenosis[J].Orthop Surg,2015,7(3):208-212.
[2]Okada K,Oka S,Tohge K,et al.Thoracic myelopathy caused by ossification of the:clinicopathologic study and surgical treatment[J].Spine,1991,16(3):280-287.
[3]Kang KC,Lee CS,Shin SK,et al.Ossification of the ligamentum flavum of the thoracic spine in the Korean population[J].J Neurosurg Spine,2011,14(4):513-519.
[4]陈会平.经皮微通道显微镜手术治疗局灶性胸椎黄韧带的疗效观察及其影响因素分析[J].颈腰痛杂志,2018,39(1):5-8.
[5]Trivedi P,Behari S,Paul L,et al.Thoracic myelopathy secondary to ossified ligamentum flavum[J].Acta Neurochir(Wien),2001,143(8):775-782.
[6]Epstein NE,Schwall G.Thoracic spinal stenosis:diagnostic and treatment challenges[J].J Spinal Disord,1994,7(3):259-269.
[7]Li F,Chen Q,Xu K.Surgical treatment of 40 patients with thoracic ossification of the ligamentum flavum[J].J Neurosurg Spine,2006,4(3):191-197.
[8]Park BC,Min WK,Oh CW,et al.Surgical outcome of thoracic myelopathy secondary to ossification of ligamentum flavum[J].Joint Bone Spine,2007,74(6):600-605.
[9]贾连顺.黄韧带骨化与胸椎椎管狭窄症[J].脊柱外科杂志,2007,5(3):185-187.
[10]Wang VY,Kanter AS,Mummaneni PV.Removal of ossified ligamentum flavum via a minimally invasive surgical approach[J].Neurosurg Focus,2008,25(2):E7.
[11]陈春美,庄源东,傅超锋,等.经皮微通道单侧入路双侧减压术治疗腰椎管狭窄[J].中华神经外科杂志,2016,32(12):1208-1213.
[12]Yeung AT,Yeung CA.Advances in endoscopic disc and spine surgery:foraminal approach[J].Surg Technol Int,2003,11(11):255-263.
[13]Hoogland T,Schubert M,Miklitz B,et al.Transforaminal posterolateral endoscopic discectomy with or without the combination of a low-dose chymopapain:a prospective randomized study in 280 consecutive cases[J].Spine,2006,31(24):E890-897.
[14]Ruetten S,Komp M,Merk H,et al.Use of newly developed instruments and endoscopes:ful-endoscopic resection of lumbar disc herniation via the interlaminar and lateral transforaminal approach[J].J Neurosurg Spine,2007,6(6):521-530.
[15]Jang JS,An SH,Lee SH.Transforaminal percutaneous endoscopic discectomy in the treatment of foraminal and extraforaminal lumber disc herniations[J].J Spinal Disord Tech,2006,19(5):338-343.
[16]陈会平.经皮微通道显微镜手术治疗局灶性胸椎黄韧带的疗效观察及其影响因素分析[J].颈腰痛杂志,2018,39(1):5-8.
[17]Ahn Y,Lee HY,Lee SH,et al.Dural tears in percutaneous endoscopic lumbar discectomy[J].Eur Spine J,2011,20(1):58-64.
[18]Oppenheimer JH,DeCastro I,McDonnell DE.Minimally invasive spine technology and minimally invasive spine surgery:a historical review[J].Neurosurg Focus,2009,27(3):E9.
[19]Guo JJ,Luk KD,Karppinen J,et al.Prevalence,distribution,and morphology of ossification of the ligamentum flavum:a population study of one thousand seven hundred thirty-six magnetic resonance imaging scans[J].Spine,2010,35(1):51-56.
[20]Chen ZQ,Sun CG.Spine Surgery Group of Chinese Orthopedic Association.Clinical for treatment of sympotomatic thoracic spinal tenosis[J].Orthop Surg,2015,7(3):208-212.