【摘要】 目的 比较用分步释压、骨化区椎板揭盖法和单纯揭盖法治疗重度黄韧带骨化症的临床疗效和应用价值。方法 2010年2月至2020年10月天水市第一人民医院骨科共手术治疗重度胸椎黄韧带骨化症患者37例；其中应用分步释压、骨化区椎板揭盖法手术20例(观察组),采取单纯揭盖法手术17例(对照组)。术后观察两组单节段平均手术时间、平均单节段术中出血量、住院时间。于术后随访观察并发症发生率及脊髓功能日本骨科协会评分(JOA 11)改善率等进行比较。结果 术后37例全部得到随访。观察组平均单节段手术时间为(91.19±22.58)min;术中单节段出血为(387.25±110.16)ml;住院时间为(9.85±1.60)d;末次随访JOA评分为(9.85±1.46)分；改善率为(83.53±16.92)%,术后肌力减退发生率为5.00%。对照组单节段手术时间为(79.80±21.27)min;术中平均单节段出血为(344.22±120.68)ml;住院时间为(9.82±1.19)d;末次随访JOA评分为(8.12±1.93)分；改善率为(58.39±23.92)%;术后肌力减退发生率为29.41%。两组比较JOA评分及JOA评分改善率差异有统计学意义(P<0.05);单节段手术时间及术中单节段出血量及住院时间差异无统计学意义(P>0.05)。结论 分步释压、骨化区椎板揭盖法手术相比较单纯揭盖法治疗重度黄韧带骨化症更加安全、可靠；前者有更高的临床推广应用价值。更多还原

【Abstract】 Objective To compare the clinical efficacy and application value between step-by-step pressure relief and simple uncovering the lamina of ossified zone simple uncovering the lamina of ossified zone for severe ossification of ligamentum flavum. Methods From February 2010 to October 2020, a total of 37 patients with severe ossification of ligamentum flavum of thoracic spine were treated surgically in Department of orthopedics, the first people’s Hospital of Tianshu. Twenty patients were treated with step-by-step decompression(observation group); seventeen patients were treated with simple uncovering of vertebral canal(control group). The operation time, intraoperative blood loss, hospital stay time, complication rate and improvement rate of Japanese Orthopaedic Association Scores(JOA) were compared between the two groups. Results All patients were followed up. The operation time of single segment in the observation group was(91.19±22.58)min; the single segment bleeding was(387.25±110.16)ml; hospital stay time(9.85±1.60)d. The JOA was(9.85±1.46) score at the last follow-up; the improvement rate was(83.53±16.92)%; and the incidence of lower limb muscle strength decrease was 5.00%. The operation time of single segment in the control group was(79.80±21.27)min; the blood loss of single segment was(344.22±120.68)ml; hospital stay time(9.82±1.19)d; the JOA was(8.12±1.93) score at the last follow-up; the improvement rate was(58.39±23.92)%; and the incidence of lower limb muscle strength decrease was 29.41%. There were significant differences in JOA score and improvement rate of JOA score between the two groups(P<0.05). There was no significant difference in single segment operation time, intraoperative blood loss and hospital stay time(P>0.05). Conclusion Step by step pressure relief and uncovering the lamina of ossified zone is safer and more reliable than simple uncovering the lamina of ossified zone for severe ossification of ligamentum flavum.更多还原