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| 胸椎后路椎体骨化物复合体前移技术治疗多节段严重胸椎后纵韧带骨化症 |
| 孙璟川,袁笑秋,王元,徐锡明,郭永飞,陈德玉,缪锦浩,侯洋,陈宇,史建刚* |
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(海军军医大学(第二军医大学)长征医院脊柱二科, 上海 200003
*通信作者) |
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| 摘要: |
| 目的 介绍一种治疗多节段严重胸椎后纵韧带骨化症的术式。方法 报道1例接受胸椎后路椎体骨化物复合体前移技术治疗的严重多节段胸椎后纵韧带骨化症病例，介绍手术步骤并分析临床资料。手术主要包括以下步骤：游离椎体骨化物复合体（前移节段上下椎间盘的松解、游离肋骨、放置椎板固定板、游离椎板）、置入椎弓根螺钉、安装钛棒、前移椎体骨化物复合体。结果 患者术后神经功能恢复良好，改良日本骨科协会评分（m-JOA）改善率为75%。手术耗时480 min，术中出血1 000 mL，术前测量椎管狭窄率为86.6%（T2/3）、68.2%（T4），术后椎管狭窄率降低为58.8%（T2/3）和45.9%（T4）。结论 胸椎后路椎体骨化物复合体前移技术通过后方入路将椎体骨化物复合体进行游离，借助钉棒系统将椎体骨化物向腹侧推移，达到对脊髓的直接减压。该病例证明此技术治疗严重多节段胸椎后纵韧带骨化症具有可行性，且技术简单，操作均位于椎管外，无需切除骨化物，理论上减压操作安全有效，但该技术的临床效果仍需更多的临床研究加以验证。 |
| 关键词: 胸椎 前移 后纵韧带骨化 椎体-骨化物复合体 |
| DOI：10.16781/j.0258-879x.2020.01.0063 |
| 投稿时间：2019-06-20修订日期：2019-12-02 |
| 基金项目:国家自然科学基金（81802218），上海市科学技术委员会重点基础研究领域项目（18441905800）. |
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| Antedisplacement and fixation of thoracic vertebra-ossification of posterior longitudinal ligament complex for treatment of severe multi-level thoracic ossification of posterior longitudinal ligament |
| SUN Jing-chuan,YUAN Xiao-qiu,WANG Yuan,XU Xi-ming,GUO Yong-fei,CHEN De-yu,MIAO Jin-hao,HOU Yang,CHEN Yu,SHI Jian-gang* |
(Department of Spine Surgery(Ⅱ), Changzheng Hospital, Naval Medical University(Second Military Medical University), Shanghai 200003, China
*Corresponding author) |
| Abstract: |
| Objective To introduce a technical innovation for the treatment of severe multi-level thoracic ossification of posterior longitudinal ligament (OPLL). Methods The detailed surgical procedure included isolation of vertebra-OPLL complex (VOC), implantation of screws and rods, and antedisplacement of the VOC. A patient diagnosed as multi-level thoracic OPLL with myelopathy was treated by this technique and the outcomes were reported. Results Neurological outcomes achieved an evident improvement, with the recovery rate of modified-Japanese Orthopaedic Association score being 75%. The operation took 480 min and the intraoperative bleeding was 1 000 mL. Postoperative computed tomography and magnetic resonance imaging showed sufficient decompression of spinal cord. The occupation ratio of spinal canal improved from 86.6% to 58.8% in T2/3, and from 68.2% to 45.9% in T3/4. Conclusion Posterior thoracic vertebra-OPLL complex antedisplacement and fixation is a feasible, theoretically safe and effective surgical option for the treatment of severe multi-level thoracic OPLL with myelopathy. The operation is simple and performed outside the spinal canal, and no ossified mass is removed. However, further studies with large-scale cases and control groups are required to reveal the applicability and safety of this technique. |
| Key words: thoracic vertebra antedisplacement ossification of posterior longitudinal ligament vertebra-ossification complex |
