单侧双通道内镜技术治疗胸椎黄韧带骨化症
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赵加庆,在读硕士,研究方向:骨外科,(电话)15677081550,(电子信箱)1627999428@qq.com

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R687

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山东省自然科学基金资助项目(编号:ZR2017LH020);山东省医药卫生科技计划(编号:2013WS0300)


Unilateral biportal endoscopic decompression for thoracic ossification of the ligamentum flavum
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    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。

    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.

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赵加庆,于先凯,赵子豪,等. 单侧双通道内镜技术治疗胸椎黄韧带骨化症[J]. 中国矫形外科杂志, 2023, 31 (7): 619-624. DOI:10.3977/j. issn.1005-8478.2023.07.08.
ZHAO Jia-qing, YU Xiankai, ZHAO Zi-hao, et al. Unilateral biportal endoscopic decompression for thoracic ossification of the ligamentum flavum[J]. Orthopedic Journal of China , 2023, 31 (7): 619-624. DOI:10.3977/j. issn.1005-8478.2023.07.08.

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  • 收稿日期:2022-06-06
  • 最后修改日期:2022-12-16
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  • 在线发布日期: 2023-04-20
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