内固定治疗胸椎后纵韧带骨化的效果及对并发症发生的影响

黄健 麦宗梨 谢永辉

【摘要】 目的：探討内固定治疗胸椎后纵韧带骨化的效果及对并发症的影响。方法：选取2017年1月-2020年1月在本院接受治疗的90例胸椎后纵韧带骨化患者，采用随机数字表法分为研究组和对照组，每组45例。对照组应用后路全椎板切除减压治疗，研究组应用后路360°环形减压椎弓根螺钉内固定治疗。比较两组患者的并发症发生情况、手术情况、手术后6个月疗效以及手术前和手术后3、6个月的JOA评分。结果：研究组并发症发生率、术中出血量、手术时间均少于对照组，差异均有统计学意义（P<0.05）。手术前，两组JOA评分比较，差异无统计学意义（P>0.05）;手术后3、6个月，研究组JOA评分均高于对照组，差异均有统计学意义（P<0.05）。手术后6个月，研究组总有效率高于对照组，差异有统计学意义（P<0.05）。结论：胸椎后纵韧带骨化患者采用内固定治疗，可以增强疗效，安全性较高，降低胸椎后纵韧带骨化患者术后并发症发生率，值得应用推广。

【关键词】 胸椎后纵韧带骨化 内固定 并发症

[Abstract] Objective： To investigate the effect of internal fixation on ossification of posterior longitudinal ligament of thoracic spine and its effect on complications. Method： A total of 90 patients with ossification of posterior longitudinal ligament of thoracic spine in our hospital from January 2017 to January 2020 were selected， and they were divided into study group and control group according to random number table， 45 cases in each group. The control group received posterior total laminectomy and the study group received posterior 360° circumferential decompression and pedicle screw internal fixation. The incidence of complications， surgical situation were compared between two groups， curative effect of 6 months after surgery and JOA scores before surgery and 3， 6 months after surgery were compared between two groups. Result： The incidence of complications， intraoperative blood loss and surgery time of the study group were lower than those of the control group ，the differences were statistically significant （P<0.05）. Before surgery， there was no significant difference in JOA score between two groups （P>0.05）; the JOA scores of the study group at 3， 6 months after surgery were higher than those of the control group， the differences were statistically significant （P<0.05）. 6 months after surgery， the total effective rate of the study group was higher than that of the control group， the difference was statistically significant （P<0.05）. Conclusion： Internal fixation in patients with ossification of posterior longitudinal ligament of thoracic spine can enhance the efficacy， improve the safety， reduce the incidence of postoperative complications in patients with ossification of posterior longitudinal ligament of thoracic spine， and it is worthy of further application and promotion.

[Key words] Ossification of posterior longitudinal ligament of thoracic spine Internal fixation Complications

First-authors address： Yangjiang Third Peoples Hospital， Yangjiang 529500， China

doi：10.3969/j.issn.1674-4985.2021.18.037

在临床上，胸椎后纵韧带骨化（OPLL）是一种不多见且不清楚病因的病理现象，有研究报道，胸椎后纵韧带骨化的发生率在0.8%左右[1]。胸椎后纵韧带骨化症呈进行性加重状态，造成较重的脊髓损伤，严重时甚至瘫痪，给患者的生活质量带来了严重影响[2]。目前，临床治疗胸椎后纵韧带骨化患者的唯一方法是手术[3]。不过，因为大髓动脉无法延伸至胸椎脊髓，因此，胸椎脊髓属于缺血区，在手术中，很容易出现缺血再灌注损伤，进而加重病情，同时，胸椎具有后凸的特点，在脊柱外科中，手术治疗胸椎后纵韧带骨化是难度大、具有挑战的手术[4]。本院胸椎后纵韧带骨化患者采用内固定治疗，获得满意疗效，现报道如下。

1 资料与方法

1.1 一般资料 选取2017年1月-2020年1月在本院接受治疗的90例胸椎后纵韧带骨化患者。……