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1、黃韌帶骨化癥型胸椎管狹窄癥臨床特點及手術(shù)治療【摘要】［目的］探討黃韌帶骨化癥型胸椎管狹窄癥(OLF-TSS)的臨床特點及手術(shù)治療效果。［方法］1998年10月?2007年2月采用整塊半關(guān)節(jié)突全椎板切除術(shù)治療38例0LF-TSS患者。其中男25例，女13例；年齡29?71歲，平均48歲。病變位于T10-L13個椎間盤水平31例(占81.6%)。平均病程10個月。5.3%合并胸椎間盤突出。［結(jié)果］38例患者全部獲得隨訪1?8年，平均3年6個月。4例術(shù)中發(fā)生硬脊膜損傷;3例術(shù)后發(fā)生腦脊液漏，均經(jīng)以俯臥
2、位為主的綜合保守治療后痊愈。按照王自立臨床療效評價標準，優(yōu)25例,良11例，無改變2例，優(yōu)良率94.7%o未出現(xiàn)定位錯誤和神經(jīng)功能惡化者。［結(jié)論JOLF-TSS臨床表現(xiàn)復雜，常見癥狀包括下肢麻木無力、腰背痛、間歇性跛行、束帶感和括約肌功能障礙。癥狀和體征結(jié)合X線、MRI及CT檢查是確診的有效手段。采用整塊半關(guān)節(jié)突全椎板切除術(shù)進行胸椎管后壁減壓是安全、有效的方法。減少失誤和并發(fā)癥的對策是確定責任節(jié)段和規(guī)范手術(shù)操作?！娟P(guān)鍵詞】黃韌帶骨化癥；胸椎管狹窄癥；外科治療Abstract：[Objective
3、]Toevaluatetheclinicalcharacteristicsandeffectofoperativetreatmentfortheossificationofligamentumflavumthoracicspinalstenosis(OLF-TSS).[Methods]FromOctober1998toFebruary2007,38patientswithOLF-TSSweretreatedwithenblochemi-articularprocesslaminectomy.In
4、thisgroup,25casesweremale,and13caseswerefemale.Theaverageagewas48years(range,29?71years)?Totally81.6%ofthelesionwasbetweenT10?LIintervertebraldiscspace.Theaveragehistorywas10months?Therewere5.3percentwithprotrusionofintervertebraldiscofthoraciospine.
5、[ResuIts]Thirty-eightcaseswerefollowed-upfor1?8years,withanaverageof3yearsand6months.Duralinjuryoccurredin4casesof38,3casesappearedpostoperativecerebrospinalfluidleakage?Allcaseswerecuredconservativelymainlywithbedrestintheprostratepositicrn.Accordin
6、gtoWANG?sevaluation,25hadexcellentresults,11hadgoodresults,2hadnochangeandnonewaspoor,Theexcellenttogoodratewas94.7%inthisgroup.TherewerenopatientswiththewrongleveLNopatientneurologicalfunctionsweredeteriorated.[Conclusion]ThechinicalfeaturesofOLF-TS
7、Sareverycomplex?Thecommonsymptomsofthediseaseareprogressiveonsetofnumbness,weakness,lowbackpain,intermittentclaudicationofthelowerextremities,constrietionontrunkorlowerlimbsandsphincterdysfunction.Theclinicalpresentationandneurologicalexaminationasso
8、ciatedwithX-rayfilm,MRIandCTweretheimportantmeansofthediagnosisofthedisease?RemovaloftheposteriorwallofthethoracicspinalcanalviathetechniqueofenblocdiminishingfauItandcomplicationsistodiscriminatepathogenicsegment(locating-diagnosis)andfollowtheprinc
