单侧双通道内镜技术治疗胸椎黄韧带骨化症△

Unilateral biportal endoscopic decompression for thoracic ossification of the ligamentum flavum

摘要:

［目的］ 探讨单侧双通道内镜技术 （unilateral biportal endoscopic, UBE） 治疗胸椎黄韧带骨化症 （thoracic ossification of ligament flavum, TOLF）的疗效及可行性。［方法］回顾性分析 2018 年 1 月—2021 年 5 月本科收治的 29 例 TOLF 患者的临床资料，依据医患沟通结果，12 例行 UBE 治疗（UBE 组），17 例行传统全椎板切除术治疗（开放组），比较两组围手术期、随访及影像结果。［结果］所有患者均顺利完成手术且无严重并发症发生。UBE 组切口总长度、下地行走时间、住院时间均显著优于开放组（P<0.05），但术中透视次数显著多于开放组（P<0.05）。两组手术时间、切口愈合等级的差异均无统计学意义（P>0.05）。 随访时间平均（14.0±1.3）个月，UBE 组恢复完全负重活动时间显著早于开放组（P<0.05）。术后随时间推移，两组的 ODI 评分、 JOA 评分、锥体束征情况均显著改善（P<0.05），相应时间点，两组上述指标的差异均无统计学意义（P>0.05）。影像方面，两组术后胸椎后凸角、椎管面积、椎管矢状径均显著增大（P<0.05）。术前两组间上述影像指标的差异均无统计学意义（P>0.05）,术后 1 个月及末次随访时，UBE 组的胸椎后凸角和术后后侧骨丢失均显著小于开放组（P<0.05）。［结论］ UBE 及传统全椎板切除术均可有效治疗 TOLF，相比之下，UBE 创伤更小、对骨结构及稳定性破坏更少，术后恢复更快，并可减少术后胸椎后凸。

关键词:胸椎黄韧带骨化症;胸椎椎管狭窄症;单侧双通道内镜技术;全椎板切除术

Abstract:

[Objective] To explore the efficacy and feasibility of the unilateral biportal endoscopic (UBE) decompression for thoracic os- sification of ligament flavum (TOLF) . [Methods] A retrospective study was performed on 29 patients who receiced surgical decompression for TOLF in our hospital from January 2018 to May 2021. Bases on preoperative doctor-patient communication, 12 patients underwent UBE, while the rmaining 17 patients were treated with the traditional open laminectomy. The documents regarding perioperative period, follow-up and radiographs were compared between the two groups. [Results] All patients in both groups had corresponding surgical procedures per- formed successfully without serious complications. The UBE group proved significantly superior to the open group in terms of total incision length, postoperative walking time and hospital stay (P＜0.05) , regardless of that the former took significantly more intraoperative fluoroscopy than the latter (P＜0.05) . However, there were no significant differences in terms of operation time and incision healing grade. All patinets in both group were followed up for (14.0±1.3) months on a mean, and the patients in the UBE group resumed full weight-bearing activity signifi- cantly earlier than those in the open group (P＜0.05) . The ODI and JOA scores, as well as pyramidal tract sign significantly improved over time in both groups (P＜0.05) , whereas which were not statistically significant between the two groups at any matching time points (P＞0.05) . Radiographically, the thoracic kyphosis angle, the spinal canal area and the sagittal diameter of the spinal canal were significantly increased in both groups after operation (P＜0.05) . Althogh no significant differences in aforesaid imaging data were found between the two groups pre- operatively (P＞0.05) , the UBE group had significantly less thoracic kyphosis angle and posterior bone loss than the open group postopera- tively (P＜0.05) , regardless of no significant differences in spinal canal area and canal sagittal diameter between them postoperatively (P＞ 0.05) . [Conclusion] Both UBE and open decompression are effective treatments for TOLF. By comparison, the UBE takes benefits of reduc- ing iatrogentic trauma with minimal bone structure and stability affected, facilitating postoperative recovery, declining the postoperative tho- racic kyphosis.

Key words:thoracic ossification of ligament flavum; thoracic spinal stenosis; unilateral biportal endoscopy; total laminectomy