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首页> 外文期刊>Journal of clinical neuroscience: official journal of the Neurosurgical Society of Australasia >Surgical strategies for ossified ligamentum flavum associated with dural ossification in thoracic spinal stenosis
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Surgical strategies for ossified ligamentum flavum associated with dural ossification in thoracic spinal stenosis

机译：胸椎管狭窄症伴硬脑膜骨化的黄韧带骨化症的手术策略

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摘要

We describe two surgical strategies for treating thoracic spinal stenosis (TSS) with ossification of the ligamentum flavum (OLF) and dural ossification (DO), and discuss their postoperative efficacy. From January 2004 to June 2008, 147 patients underwent TSS surgery. Thirty three of those with intraoperative evidence of OLF and DO were included in the present study. Based on the different intraoperative treatment of the dura, these 33 patients were divided into two groups: Group A, 17 patients who had their dura slit and the ossification excised, and Group B, 16 patients treated by floating the ossified dura by thinning it with a drill. All patients underwent outpatient follow-up. Pre- and postoperative Japanese Orthopaedic Association (JOA) scores and recovery rates were evaluated. The mean follow-up period was 42 months. The incidence of DO with OLF in TSS was 22%. At 1 year follow-up, the mean JOA score improved from 5.12 +/- 1.17 to 6.94 +/- 0.90 in Group A and from 5.25 +/- 1.34 to 7.13 +/- 1.41 in Group B. Additionally, the mean JOA score improved from 5.18 +/- 1.24 to 7.03 +/- 1.16 in TSS patients with DO and from 5.52 +/- 1.21 to 7.21 +/- 1.18 in TSS patients without DO. The increased cross-sectional area of the pre- and postoperative dural sac at the level of stenosis suggested that decompression was complete. Both decompression methods are feasible for curing TSS with OLF and DO. Moreover, slitting the dura for ossified dura and ligamentum flavum removal to relax the spinal cord is a safe and reliable method. Even though it increased the surgical difficulties and risks, DO did not affect postoperative neurological recovery. (C) 2014 Elsevier Ltd. All rights reserved.
机译：我们描述了两种治疗策略，分别是黄韧带骨化（OLF）和硬脑膜骨化（DO）合并胸椎管狭窄（TSS），并讨论了它们的术后疗效。从2004年1月到2008年6月，有147例患者接受了TSS手术。本研究中包括33例有术中OLF和DO证据的患者。根据不同的术中硬脑膜治疗方法，将这33例患者分为两组：A组17例行切开硬膜切开并骨化的患者; B组16例通过将硬化的硬膜薄化一次演习;一个钻头。所有患者均接受门诊随访。评估了日本骨科协会（JOA）的术前和术后得分和恢复率。平均随访期为42个月。 TSS中OLF引起的DO发生率为22％。在1年的随访中，A组的平均JOA评分从5.12 +/- 1.17改善到6.94 +/- 0.90，B组的平均JOA评分从5.25 +/- 1.34改善到7.13 +/- 1.41。患有DO的TSS患者从5.18 +/- 1.24改善到7.03 +/- 1.16，而没有DO的TSS患者从5.52 +/- 1.21改善到7.21 +/- 1.18。在狭窄水平上，术前和术后硬膜囊的横截面积增加表明减压已完成。两种减压方法对于用OLF和DO固化TSS都是可行的。此外，切开硬脑膜以去除骨化硬脑膜和黄韧带以松弛脊髓是一种安全可靠的方法。尽管增加了手术难度和风险，但DO并没有影响术后神经恢复。 （C）2014 Elsevier Ltd.保留所有权利。

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