CT引导下经皮后路脊柱内镜治疗胸椎黄韧带骨化症的疗效分析

Analysis of curative effect of CT-guided percutaneous posterior spinal endoscopy for thoracic ossification of the ligamentum flavum

摘要:

目的 探索CT引导下经皮后路脊柱内镜手术治疗胸椎黄韧带骨化症（thoracic ossification of the ligamentum flavum，TOLF）的安全性和有效性。 方法 纳入2021年11月至2022年1月收治的胸椎黄韧带骨化症（TOLF）6例，在CT引导结合环锯锚定下完成经皮后路脊柱内镜手术。记录患者的基本信息、症状、手术节段、术中并发症等。应用医学影像处理软件计算术前、术后横断面椎管面积残余率。于术前、术后3天、术后6月应用疼痛视觉模拟评分( Visual Analogue Scale，VAS) 评价疼痛；在术前、术后6月以Oswestry功能障碍指数评分（ODI评分）评估功能恢复情况；在术后6月采用改良MacNab 分级评估临床预后。 结果 6例患者顺利完成手术，术后3天、术后6月VAS评分分别为1.50±0.55、0.33±0.52，显著低于术前6.00±1.10（P＜0.05）；术后6月ODI为5.56%±5.58%，显著低于术前69.63%±12.62%（P＜0.05）。横断面椎管面积残余率术前、术后分别为81.86%±9.61%、96.30%±9.21%（P＜0.05）。改良MacNab 分级评估“优良率”为100%。1例患者术后出现肋间神经痛，3天后恢复。其他病例均无神经根和/或脊髓损伤、硬膜囊撕裂、脑脊液漏、椎管内血肿、感染等并发症。 结论 CT引导下经皮后路脊柱内镜手术治疗胸椎黄韧带骨化症安全、有效，值得进一步行大样本多中心随机对照试验。

Abstract:

Abstract: 【Objective】To explore the safety and efficacy of CT-guided percutaneous posterior spinal endoscopy for the treatment of thoracic ossification of the ligamentum flavum (TOLF).【Methods】From November 2021 to January 2022, 6 patients with TOLF were performed percutaneous posterior spinal endoscopy guided by CT combined with ring saw anchoring The basic information, symptoms, surgical segments and intraoperative complications of the patients were recorded. The residual rate of transverse spinal canal area was calculated by using medical imaging software before and after operation. The Visual Analogue Scale (VAS) was used to assess pain before surgery, 3 days after surgery, and 6 months after surgery. The preoperative and postoperative Oswestry Disability Index ( ODI) was used to assess functional recovery. Clinical outcomes were assessed by modified MacNab grading at 6 months postoperatively. 【Results】The operation was completed successfully in 6 patients, The VAS scores at 3 days and 6 months after surgery were 1.50±0.55、0.33±0.52, significantly lower than 6.00±1.10 before surgery （P＜0.05）.ODI at 6 months after surgery was5.56%±5.58%, significantly lower than 69.63%±12.62% before surgery（P＜0.05）. The residual rate of transverse spinal canal area before and after operation were 81.86%±9.61% and 96.30%±9.21%, respectively (P < 0.05).The excellent and good efficacy rates in modified MacNab grading were100.0%. one of the 6 patientsdeveloped intercostal neuralgia after surgery and recovered 3 days later. There were no complications such as nerve root and/or spinal cord injury, dural sac tear, cerebrospinal fluid leakage, intraspinal hematoma, and infection in the other cases.【Conclusions】CT-guided percutaneous posterior spinal endoscopic surgery for TOLF is safe and effective, which is worthy of further large-sample multicenter randomized controlled trial.