全可视内镜下内层骨板预保留法在胸椎椎管狭窄减压术中的应用及安全性评价

Application and safety evaluation of the pre-preservation method of inner bone plate under full visual endoscopy in decompression of thoracic spinal stenosis

摘要:

目的 探讨全可视内镜下内层骨板预保留法在胸椎椎管狭窄减压术中的应用及安全性。方法 选取2018年1月－2024年1月该院确诊为黄韧带骨化症（TOLF）导致的单节段胸椎椎管狭窄，行全可视内镜下减压术的患者51例。所有患者术中均采用椎板间入路内层骨板预保留法切除骨化的黄韧带。于术后3 d、术后1个月和术后3个月，采用日本骨科协会（JOA）评分和Oswestry功能障碍指数（ODI）评估胸椎功能；采用视觉模拟评分法（VAS）评估患者症状恢复情况；观察神经功能改善情况。结果 入组患者手术过程顺利，术后无脊髓损伤等并发症发生；平均手术时间为（94.3±10.4）min，平均出血量为（43.9±8.6）mL，神经功能改善率为100.00%；术后3个月，JOA评分为（8.1±1.4）分，较术前的（3.9±2.7）分明显升高，差异有统计学意义（P = 0.014）；术后3 d的VAS评分为（3.7±2.1）分，较术前的（6.4±1.9）分明显降低，差异有统计学意义（P = 0.020）；术后3 d和术后1个月的ODI由术前的（65.46±16.37）%降低至（39.19±14.33）%和（30.76±11.51）%，差异有统计学意义（P = 0.003）。结论 全可视内镜下内层骨板预保留法治疗TOLF导致的胸椎椎管狭窄，是一种安全、可靠且有效的手术方法。值得临床推广应用。

Abstract:

Objective To investigate the application and safety of the inner bone plate preservation method in the decompression of thoracic spinal stenosis under full visual endoscopy.Methods 51 patients diagnosed with single-segment thoracic spinal canal stenosis caused by thoracic ossification of ligamentum flavum (TOLF) from January 2018 to January 2024 and undergoing full visual endoscopic decompression were selected. All patients underwent intraoperative resection of the ossified ligamentum flavum using the interlaminar approach and the pre-preservation method of the inner bone plate. The thoracic vertebra function was evaluated using the Japanese Orthopaedic Association (JOA) score and the Oswestry disability index (ODI) at 3 days, 1 month and 3 months after the operation. The visual analogue scale (VAS) score was used to evaluate the recovery of patients' symptoms. Observe the improvement of the patient's symptoms.Results The surgical process of the enrolled patients went smoothly, and no complications such as spinal cord injury symptoms occurred after the operation. The average operation time was (94.3 ± 10.4) minutes, the average blood loss was (43.9 ± 8.6) mL, and the total effective rate of treatment was 100.00%. 3 months after the operation, the JOA score was (8.1 ± 1.4), which was significantly higher than that before the operation (3.9 ± 2.7), and the difference was statistically significant (P = 0.014). The VAS score 3 days after the operation was (3.7 ± 2.1), which was significantly lower than that before the operation (6.4 ± 1.9), and the difference was statistically significant (P = 0.020). The ODI scores at 3 days and 1 month after the operation decreased from (65.46 ± 16.37)% before the operation to (39.19 ± 14.33)% and (30.76 ± 11.51)%, respectively, and the difference was statistically significant (P = 0.003).Conclusion The pre-preservation of the inner bone plate under full visual endoscopy for thoracic spinal stenosis caused by TOLF is a safe, reliable and effective surgical method. It is worthy of clinical promotion and application.