胸椎黄韧带骨化内镜下保留关节突减压△（开放获取）

Endoscopic decompression with facet process preservation for thoracic ossification of ligamentum flavum (Open Access)

摘要:

[目的] 介绍胸椎黄韧带骨化内镜下保留关节突减压的手术治疗技术和初步临床结果。[方法] 24 例胸椎黄韧带骨化患者采用上述手术治疗，采用俯卧位，局部麻醉+静脉麻醉，C 形臂 X 线机透视引导下环锯锚定病椎关节突内侧椎板，接入内镜系统可视下环切同侧椎板，显露硬脊膜，配合椎板咬骨钳、磨钻进一步切除椎板的头尾两端，跨越棘突根部切除对侧椎板，同时分离切除椎管内黄韧带及骨化物。减压至硬脊膜两侧边缘，骨化物头尾两端 1 cm 以上，见硬脊膜搏动，彻底止血， 术毕。[结果]患者均顺利完成手术，术中无硬脊膜撕裂及神经、血管损伤等严重并发症。与术前相比，术后 3 个月、末次随访时，VAS 评分 [(6.2±0.9), (1.6±0.7), (1.5±0.5), P＜0.001] 、ODI 评分 [(55.4±8.2), (18.6±3.1), (8.5±1.2), P＜0.001] 显著改善，改良 Macnab 疗效评定标准优良率为 83.3%。[结论]胸椎黄韧带骨化内镜下保留关节突减压术，可术中保留双侧关节突，并可充分减压椎管，避免后期医源性不稳，是一种安全有效的术式。

Abstract:

[Objective] To introduce the surgical techniques and preliminary outcomes of endoscopic decompression with facet process preservation for thoracic ossification of ligamentum flavum. [Methods] A total of 24 patients underwent abovementioned surgical treatment for thoracic ossification of ligamentum flavum. The patient was paced in prone position, and local anesthesia combined with intravenous anesthesia were used. Under C-arm fluoroscopy, a trephine was inserted onto the facet process medial margin of the affected segment. As the endoscopic system was connected, partial ipsilateral laminectomy was conducted to expose the dura with the visualizing trephine. By using laminar rongeur and grinding drill, the ipsilateral lamina was completely resected cephalocaudally. Furthermore, the contralateral lamina was removed under the base of the spinous process, and the ossified ligamentum flavum involving the spinal canal were separated and excised gradually to finish decompression to both sides of the dural edge, 1 cm above and below of the ossified ligament to regain dural pulsation. After complete hemostasis, the incision was closed in layers. [Results] All the patients were operated successfully with no serious complications, such as dural tear, nerve and blood vessel injury. Compared with those preoperatively, VAS score [(6.2±0.9), (1.6±0.7), (1.5±0.5), P＜0.001], ODI score [(55.4±8.2), (18.6±3.1), (8.5±1.2), P＜0.001] significantly improved 3 months postoperatively and at the latest follow-up. Based on the modified Macnab's criteria, the excellent and good rate of clinical outcomes was of 83.3%. [Conclusion] This endoscopic decompression with facet process preservation for thoracic ossification of ligamentum flavum is a safe and effective surgical procedure with advantage of sufficient decompression of the spinal canal and avoiding iatrogenic segmental instability in the later stage.