黄韧带V形缺损定位技术在全可视内镜胸椎后路椎板切除减压术中的应用价值及安全性研究

Application value and safety of ligamentum flavum V-shaped defect localization in full-endoscopic posterior thoracic laminectomy and decompression

摘要:

目的 探讨黄韧带V形缺损定位技术在全可视内镜下胸椎后路椎板切除减压术中的应用价值，并评价其临床疗效及安全性。方法 回顾性纳入2020年1月－2024年12月该院收治的62例单节段黄韧带骨化所致胸椎管狭窄患者的临床资料。其中，32例患者行V形缺损定位联合内镜减压术（观察组），30例行常规内镜减压术（对照组）。比较两组手术时间、术中出血量、术中透视次数及减压达标率。于术后1、3、6、12和24个月，采用视觉模拟评分法（VAS）、Oswestry功能障碍指数（ODI）、改良日本骨科协会评分（mJOA）及健康调查量表36（SF-36）评估临床疗效，并记录术后并发症的发生情况。分析围手术期相关指标与术后6个月mJOA评分之间的相关性，以及减压达标率与并发症发生率的相关性。结果 观察组手术时间短于对照组，术中出血量和透视次数少于对照组，减压达标率高于对照组，差异均有统计学意义（P < 0.05）。术后各时间点，观察组VAS评分和ODI低于对照组，mJOA评分和SF-36评分高于对照组，差异均有统计学意义（P < 0.05）。观察组并发症发生率低于对照组，差异有统计学意义（P < 0.05）。相关性分析显示，术中出血量及手术时间与术后6个月mJOA评分呈负相关（r = -0.623、r = -0.578，P < 0.05），减压达标率与并发症发生率呈负相关（r = -0.659，P < 0.05）。结论 黄韧带V形缺损定位技术应用于全可视内镜下胸椎后路椎板切除减压术，可提高术中定位及减压的准确性，缩短手术时间，减少术中出血及透视次数，有助于改善患者术后神经功能和生活质量，具有较好的临床疗效及安全性。

Abstract:

Objective To investigate the application value of the ligamentum flavum V-shaped defect localization technique in full-endoscopic posterior thoracic laminectomy and decompression and to evaluate its clinical efficacy and safety.Methods A total of 62 patients with single-level thoracic spinal stenosis caused by ossification of the ligamentum flavum who were admitted to the hospital between January 2020 and December 2024 were retrospectively included. Of these, 32 patients underwent V-shaped defect localization combined with endoscopic decompression (observation group), while 30 underwent conventional endoscopic decompression (control group). Operation time, intraoperative blood loss, number of intraoperative fluoroscopic examinations, and adequate decompression rate were compared between the two groups. Clinical efficacy was evaluated at 1, 3, 6, 12, and 24 months after surgery using the visual analogue scale (VAS), Oswestry disability index (ODI), modified Japanese Orthopaedic Association (mJOA) score, and 36-Item Short Form Health Survey (SF-36), and postoperative complications were recorded. Correlation between perioperative parameters and the mJOA score at 6 months after surgery, as well as between the adequate decompression rate and complication rate, were analyzed.Results The observation group had a shorter operation time, less intraoperative blood loss, and fewer intraoperative fluoroscopic examinations than the control group, whereas the adequate decompression rate was higher in the observation group. All differences were statistically significant (P < 0.05). At all postoperative follow-up time points, VAS scores and ODI were lower in the observation group than those in the control group, whereas mJOA scores and SF-36 scores were higher in the observation group. All differences were statistically significant (P < 0.05). The total complication rate was lower in the observation group than in the control group, and the difference was statistically significant (P < 0.05). Correlation analysis showed that intraoperative blood loss and operative time were negatively correlated with the mJOA scores at 6 months after surgery (r = -0.623 and r = -0.578, P < 0.05). The adequate decompression rate was negatively correlated with the complication rate (r = -0.659, P < 0.05).Conclusion The ligamentum flavum V-shaped defect localization technique used in full-endoscopic posterior thoracic laminectomy and decompression can improve the accuracy of intraoperative localization and decompression, shorten operative time, reduce intraoperative blood loss and fluoroscopic examinations, and contribute to improvements in postoperative neurological function and quality of life, demonstrating favorable clinical efficacy and safety.