胸椎黃韌帶骨化合并硬脊膜骨化的手術策略_《中國修復重建外科雜志》

作者：

楊忠 , 雪原 , 張超 , 代欽 , 周慧芳 , 潘建峰 , 盛旦

天津醫科大學總醫院骨科（天津，300052）;

關鍵詞：

硬脊膜骨化黃韌帶骨化硬脊膜缺損胸椎管狹窄

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目的介紹黃韌帶骨化合并硬脊膜骨化的手術策略并討論手術的可行性。方法 2006 年6 月－2009 年12 月收治黃韌帶骨化致胸椎管狹窄患者98 例，其中18 例經手術證實合并硬脊膜骨化。男11 例，女7 例；年齡46 ～ 73 歲，平均58 歲。病程5 ～ 48 個月，平均20 個月。所有患者均由于癥狀加重選擇后路減壓術，通過根黃通道八邊形游離整塊切除胸椎上關節突及骨化黃韌帶和硬脊膜。手術前后采用日本骨科協會（JOA）評分、改良Oswestry 功能障礙指數（ODI）和Cobb 角測量進行療效評價。結果術后患者初始癥狀均明顯緩解。術后18 例均出現暫時性腦脊液漏，保守治療8 ～ 10 d 后腦脊液漏停止。患者傷口均Ⅰ期愈合，無神經癥狀加重、蛛網膜下腔感染、傷口感染、竇道形成等并發癥發生。18 例均獲隨訪，隨訪時間20 ～ 60 個月，平均49 個月。末次隨訪時無脊髓壓迫復發、神經癥狀加重等。術后1、12 個月患者JOA 評分及ODI 值均較術前明顯改善（P lt; 0.05）；術后12 個月JOA 評分及療效、ODI 值均較術后1 個月明顯改善（P lt; 0.05）。術后12 個月患者Cobb 角（8.0 ± 1.2） ° 與術前（6.7 ± 1.6） ° 比較差異有統計學意義（t=4.000，P=0.001）。術后2 個月MRI 水平位、矢狀位和脂肪抑制像上顯示受壓節段脊髓膨起良好。結論根黃通道八邊形游離整塊切除胸椎上關節突及骨化黃韌帶和硬脊膜的手術方法，對于治療繼發于黃韌帶骨化和硬脊膜骨化的胸椎管狹窄安全可靠，無修補的方法對于硬脊膜缺損的處理也有效。

引用本文： 楊忠,雪原,張超,代欽,周慧芳,潘建峰,盛旦. 胸椎黃韌帶骨化合并硬脊膜骨化的手術策略. 中國修復重建外科雜志, 2012, 26(4): 401-405. doi: 復制

1.	Fong SY, Wong HK. Thoracic myelopathy secondary to ligamentum flavum ossification. Ann Acad Med Singapore, 2004, 33(3): 340-346.
2.	Sun XZ, Chen ZQ, Qi Q, et al. Diagnosis and treatment of ossification of the ligamentum flavum associated with dural ossification: clinical article. J Neurosurg Spine, 2011, 15(4): 386-392.
3.	Kang KC, Lee CS, Shin SK, et al. Ossification of the ligamentum flavum of the thoracic spine in the Korean population. J Neurosurg Spine, 2011, 14(4): 513-519.
4.	Sanghvi AV, Chhabra HS, Mascarenhas AA, et al. Thoracic myelopathy due to ossification of ligamentum flavum: a retrospective analysis of predictors of surgical outcome and factors affecting preoperative neurological status. Eur Spine J, 2011, 20(2): 205-215.
5.	Miyakoshi N, Shimada Y, Suzuki T, et al. Factors related to long-term outcome after decompressive surgery for ossification of the ligamentum flavum of the thoracic spine. J Neurosurg, 2003, 99(3 Suppl): 251-256.
6.	Muthukumar N. Dural ossification in ossification of the ligamentum flavum: a preliminary report. Spine (Phila Pa 1976), 2009, 34(24): 2654-2661.
7.	趙華健, 雪原, 李建鵬, 等. 胸椎黃韌帶骨化的病理單元及分層八邊手術法. 中華骨科雜志, 2010, 30(11): 1053-1058.
8.	趙華健, 雪原, 王沛, 等. 經根黃通道八邊形游離整塊切除胸椎上關節突及骨化黃韌帶. 中國脊柱脊髓雜志, 2010, 20(8): 669-672.
9.	雪原, 王沛, 姜建新, 等. 利用根黃通道減壓治療胸椎黃韌帶骨化合并脊髓病. 中華骨科雜志, 27(1): 10-14.
10.	Hirabayashi K, Miyakawa J, Satomi K, et al. Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament. Spine (Phila Pa 1976), 1981, 6(4): 354-364.
11.	Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976), 2000, 25(22): 2940-2952.
12.	鄭光新, 趙曉鷗, 劉廣林, 等. Oswestry功能障礙指數評定腰痛患者的可信性. 中國脊柱脊髓雜志, 2002, 12(1): 13-15.
13.	Tsukamoto N, Maeda T, Miura H, et al. Repetitive tensile stress to rat caudal vertebrae inducing cartilage formation in the spinal ligaments: a possible role of mechanical stress in the development of ossification of the spinal ligaments. J Neurosurg Spine, 2006, 5(3): 234-242.
14.	Inamasu J, Guiot BH. A review of factors predictive of surgical outcome for ossification of the ligamentum flavum of the thoracic spine. J Neurosurg Spine, 2006, 5(2): 133-139.
15.	Barnett GH, Hardy RW Jr, Little JR, et al. Thoracic spinal canal stenosis. J Neurosurg, 1987, 66(3): 338-344.
16.	Liao CC, Chen TY, Jung SM, et al. Surgical experience with symptomatic thoracic ossification of the ligamentum flavum. J Neurosurg Spine, 2005, 2(1): 34-39.
17.	Okada K, Oka S, Tohge K, et al. Thoracic myelopathy caused by ossification of the ligamentum flavum. Clinicopathologic study and surgical treatment. Spine (Phila Pa 1976), 1991, 16(3): 280-287.
18.	Fan D, Chen Z, Wang D, et al. Osterix is a key target for mechanical signals in human thoracic ligament flavum cells. J Cell Physiol, 2007, 211(3): 577-584.
19.	Zhang HQ, Chen LQ, Liu SH, et al. Posterior decompression with kyphosis correction for thoracic myelopathy due to ossification of the ligamentum flavum and ossification of the posterior longitudinal ligament at the same level. J Neurosurg Spine, 2010, 13(1): 116-122.
20.	Pascal-Moussellard H, Cabre P, Smadja D, et al. Symptomatic ossification of the ligamentum flavum: a clinical series from the French Antilles. Spine (Phila Pa 1976), 30(14): E400-405.
21.	Li F, Chen Q, Xu K. Surgical treatment of 40 patients with thoracic ossification of the ligamentum flavum. J Neurosurg Spine, 2006, 4(3): 191-197.
22.	Hida K, Iwasaki Y, Koyanagi I, et al. Bone window computed tomography for detection of dural defect associated with cervical ossified posterior longitudinal ligament. Neurol Med Chir (Tokyo), 1997, 37(2): 173-176.
23.	Aizawa T, Sato T, Sasaki H, et al. Thoracic myelopathy caused by ossification of the ligamentum flavum: clinical features and surgical results in the Japanese population. J Neurosurg Spine, 2006, 5(6): 514-519.
24.	Wang W, Kong L, Zhao H, et al. Thoracic ossification of ligamentum flavum caused by skeletal fluorosis. Eur Spine J, 16(8): 1119-1128.
25.	Tischer T, Aktas T, Milz S, et al. Detailed pathological changes of human lumbar facet joints L1-L5 in elderly individuals. Eur Spine J, 2006, 15(3): 308-315.
26.	Robertson PA, Grobler LJ, Novotny JE, et al. Postoperative spondylolisthesis at L4-5. The role of facet joint morphology. Spine (Phila Pa 1976), 18(11): 1483-1490.
27.	Gu Y, Chen L, Yang HL, et al. Efficacy of surgery and type of fusion in patients with degenerative lumbar spinal stenosis. J Clin Neurosci, 209, 16(10): 1291-1295.
28.	Kitchel SH, Eismont FJ, Green BA. Closed subarachnoid drainage for management of cerebrospinal fluid leakage after an operation on the spine. J Bone Joint Surg (Am), 1989, 71(7): 984-987.

1. Fong SY, Wong HK. Thoracic myelopathy secondary to ligamentum flavum ossification. Ann Acad Med Singapore, 2004, 33(3): 340-346.
2. Sun XZ, Chen ZQ, Qi Q, et al. Diagnosis and treatment of ossification of the ligamentum flavum associated with dural ossification: clinical article. J Neurosurg Spine, 2011, 15(4): 386-392.
3. Kang KC, Lee CS, Shin SK, et al. Ossification of the ligamentum flavum of the thoracic spine in the Korean population. J Neurosurg Spine, 2011, 14(4): 513-519.
4. Sanghvi AV, Chhabra HS, Mascarenhas AA, et al. Thoracic myelopathy due to ossification of ligamentum flavum: a retrospective analysis of predictors of surgical outcome and factors affecting preoperative neurological status. Eur Spine J, 2011, 20(2): 205-215.
5. Miyakoshi N, Shimada Y, Suzuki T, et al. Factors related to long-term outcome after decompressive surgery for ossification of the ligamentum flavum of the thoracic spine. J Neurosurg, 2003, 99(3 Suppl): 251-256.
6. Muthukumar N. Dural ossification in ossification of the ligamentum flavum: a preliminary report. Spine (Phila Pa 1976), 2009, 34(24): 2654-2661.
7. 趙華健, 雪原, 李建鵬, 等. 胸椎黃韌帶骨化的病理單元及分層八邊手術法. 中華骨科雜志, 2010, 30(11): 1053-1058.
8. 趙華健, 雪原, 王沛, 等. 經根黃通道八邊形游離整塊切除胸椎上關節突及骨化黃韌帶. 中國脊柱脊髓雜志, 2010, 20(8): 669-672.
9. 雪原, 王沛, 姜建新, 等. 利用根黃通道減壓治療胸椎黃韌帶骨化合并脊髓病. 中華骨科雜志, 27(1): 10-14.
10. Hirabayashi K, Miyakawa J, Satomi K, et al. Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament. Spine (Phila Pa 1976), 1981, 6(4): 354-364.
11. Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976), 2000, 25(22): 2940-2952.
12. 鄭光新, 趙曉鷗, 劉廣林, 等. Oswestry功能障礙指數評定腰痛患者的可信性. 中國脊柱脊髓雜志, 2002, 12(1): 13-15.
13. Tsukamoto N, Maeda T, Miura H, et al. Repetitive tensile stress to rat caudal vertebrae inducing cartilage formation in the spinal ligaments: a possible role of mechanical stress in the development of ossification of the spinal ligaments. J Neurosurg Spine, 2006, 5(3): 234-242.
14. Inamasu J, Guiot BH. A review of factors predictive of surgical outcome for ossification of the ligamentum flavum of the thoracic spine. J Neurosurg Spine, 2006, 5(2): 133-139.
15. Barnett GH, Hardy RW Jr, Little JR, et al. Thoracic spinal canal stenosis. J Neurosurg, 1987, 66(3): 338-344.
16. Liao CC, Chen TY, Jung SM, et al. Surgical experience with symptomatic thoracic ossification of the ligamentum flavum. J Neurosurg Spine, 2005, 2(1): 34-39.
17. Okada K, Oka S, Tohge K, et al. Thoracic myelopathy caused by ossification of the ligamentum flavum. Clinicopathologic study and surgical treatment. Spine (Phila Pa 1976), 1991, 16(3): 280-287.
18. Fan D, Chen Z, Wang D, et al. Osterix is a key target for mechanical signals in human thoracic ligament flavum cells. J Cell Physiol, 2007, 211(3): 577-584.
19. Zhang HQ, Chen LQ, Liu SH, et al. Posterior decompression with kyphosis correction for thoracic myelopathy due to ossification of the ligamentum flavum and ossification of the posterior longitudinal ligament at the same level. J Neurosurg Spine, 2010, 13(1): 116-122.
20. Pascal-Moussellard H, Cabre P, Smadja D, et al. Symptomatic ossification of the ligamentum flavum: a clinical series from the French Antilles. Spine (Phila Pa 1976), 30(14): E400-405.
21. Li F, Chen Q, Xu K. Surgical treatment of 40 patients with thoracic ossification of the ligamentum flavum. J Neurosurg Spine, 2006, 4(3): 191-197.
22. Hida K, Iwasaki Y, Koyanagi I, et al. Bone window computed tomography for detection of dural defect associated with cervical ossified posterior longitudinal ligament. Neurol Med Chir (Tokyo), 1997, 37(2): 173-176.
23. Aizawa T, Sato T, Sasaki H, et al. Thoracic myelopathy caused by ossification of the ligamentum flavum: clinical features and surgical results in the Japanese population. J Neurosurg Spine, 2006, 5(6): 514-519.
24. Wang W, Kong L, Zhao H, et al. Thoracic ossification of ligamentum flavum caused by skeletal fluorosis. Eur Spine J, 16(8): 1119-1128.
25. Tischer T, Aktas T, Milz S, et al. Detailed pathological changes of human lumbar facet joints L1-L5 in elderly individuals. Eur Spine J, 2006, 15(3): 308-315.
26. Robertson PA, Grobler LJ, Novotny JE, et al. Postoperative spondylolisthesis at L4-5. The role of facet joint morphology. Spine (Phila Pa 1976), 18(11): 1483-1490.
27. Gu Y, Chen L, Yang HL, et al. Efficacy of surgery and type of fusion in patients with degenerative lumbar spinal stenosis. J Clin Neurosci, 209, 16(10): 1291-1295.
28. Kitchel SH, Eismont FJ, Green BA. Closed subarachnoid drainage for management of cerebrospinal fluid leakage after an operation on the spine. J Bone Joint Surg (Am), 1989, 71(7): 984-987.

《中國修復重建外科雜志》

胸椎黃韌帶骨化合并硬脊膜骨化的手術策略

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《中國修復重建外科雜志》

胸椎黃韌帶骨化合并硬脊膜骨化的手術策略

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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Content

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