经后路行前方减压方法治疗胸椎后纵韧带骨化的疗效分析
Clinical manifestation of anterior decompression through posterior approach for thoracic myelopathy caused by OPLL

摘要：目的 探讨胸椎后纵韧带骨化患者的手术方式和疗效。方法 纳入2003年1月至2013年4月收治的胸椎后纵韧带骨化患者32例的临床资料。其中男14例，女18例；年龄38～72岁，平均55.6岁。其中5人曾经接受过广泛的胸椎椎板切除手术。采用经后路行前方减压胸椎后纵韧带骨化的方法(Ohtsuka术式)治疗胸椎后纵韧带骨化，即在行椎板扩大切除后，经后方斜向前切除或者漂浮骨化后纵韧带。评估患者术后效果及并发症情况。手术效果采用改良的JOA评分和Hirabayashi改良率进行评定。结果 随访2～10年，术前JOA评分5.2±1.7(0～9分)，末次随访时JOA评分为8.9±2.3(4～11分)，平均改善率(68.3±18.8)%(14%～100%)。术后2例出现迟发感染，8例发生脑脊液漏，1例出现血胸。结论 经后路行前方减压胸椎骨化后纵韧带的方法治疗胸椎后纵韧带骨化可获得较满意的临床疗效。
ABSTRACT: Objective To evaluate the outcomes of anterior decompression through posterior approach (Ohtsuka Procedure) in patients with ossification of the posterior longitudinal ligament in the thoracic spine (T-OPLL). Methods We analyzed the clinical data and follow-up of 32 patients with T-OPLL underwent anterior decompression through posterior approach from January 2003 to April 2013 in our institution. There were 14 male and 18 female patients, with a mean age of 55.6 years (38-72 years). Five of them had previously undergone extensive laminectomy for T-OPLL. Anterior decompression through posterior approach included posterior decompression by extensive laminectomy and extirpation or floating of ossified ligament. We evaluated clinical results (JOA score and recovery rate) and complications. Results All the patients were followed up with the average time of 4.5 years (ranging 2 to 10 years). The JOA score was 5.2±1.7 points preoperatively and 8.9±2.3 points at the time of the final follow-up examination, with a recovery rate of (68.3±18.8)%. Delayed infection occurred in two patients, leakage of cerebrospinal fluid in eight patients, and hemothorax in one patient. Conclusion The outcomes of anterior decompression through posterior approach (Ohtsuka Procedure) for T-OPLL are favorable