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1、黄韧带骨化症型胸椎管狭窄症临床特点及手术治疗【摘要】［目的］探讨黄韧带骨化症型胸椎管狭窄症(OLF-TSS)的临床特点及手术治疗效果。［方法］1998年10月〜2007年2月采用整块半关节突全椎板切除术治疗38例0LF-TSS患者。其中男25例，女13例；年龄29〜71岁，平均48岁。病变位于T10-L13个椎间盘水平31例(占81.6%)。平均病程10个月。5.3%合并胸椎间盘突出。［结果］38例患者全部获得随访1〜8年，平均3年6个月。4例术中发生硬脊膜损伤;3例术后发生脑脊液漏，均经以俯卧
2、位为主的综合保守治疗后痊愈。按照王自立临床疗效评价标准，优25例,良11例，无改变2例，优良率94.7%o未出现定位错误和神经功能恶化者。［结论JOLF-TSS临床表现复杂，常见症状包括下肢麻木无力、腰背痛、间歇性跛行、束带感和括约肌功能障碍。症状和体征结合X线、MRI及CT检查是确诊的有效手段。采用整块半关节突全椎板切除术进行胸椎管后壁减压是安全、有效的方法。减少失误和并发症的对策是确定责任节段和规范手术操作。【关键词】黄韧带骨化症；胸椎管狭窄症；外科治疗Abstract：[Objective
3、]Toevaluatetheclinicalcharacteristicsandeffectofoperativetreatmentfortheossificationofligamentumflavumthoracicspinalstenosis(OLF-TSS).[Methods]FromOctober1998toFebruary2007,38patientswithOLF-TSSweretreatedwithenblochemi-articularprocesslaminectomy.In
4、thisgroup,25casesweremale,and13caseswerefemale.Theaverageagewas48years(range,29〜71years)・Totally81.6%ofthelesionwasbetweenT10〜LIintervertebraldiscspace.Theaveragehistorywas10months・Therewere5.3percentwithprotrusionofintervertebraldiscofthoraciospine.
5、[ResuIts]Thirty-eightcaseswerefollowed-upfor1〜8years,withanaverageof3yearsand6months.Duralinjuryoccurredin4casesof38,3casesappearedpostoperativecerebrospinalfluidleakage・Allcaseswerecuredconservativelymainlywithbedrestintheprostratepositicrn.Accordin
6、gtoWANG?sevaluation,25hadexcellentresults,11hadgoodresults,2hadnochangeandnonewaspoor,Theexcellenttogoodratewas94.7%inthisgroup.TherewerenopatientswiththewrongleveLNopatientneurologicalfunctionsweredeteriorated.[Conclusion]ThechinicalfeaturesofOLF-TS
7、Sareverycomplex・Thecommonsymptomsofthediseaseareprogressiveonsetofnumbness,weakness,lowbackpain,intermittentclaudicationofthelowerextremities,constrietionontrunkorlowerlimbsandsphincterdysfunction.Theclinicalpresentationandneurologicalexaminationasso
8、ciatedwithX-rayfilm,MRIandCTweretheimportantmeansofthediagnosisofthedisease・RemovaloftheposteriorwallofthethoracicspinalcanalviathetechniqueofenblocdiminishingfauItandcomplicationsistodiscriminatepathogenicsegment(locating-diagnosis)andfollowtheprinc
