经皮脊柱内镜手术与传统后路椎板切除术对胸椎黄韧带骨化症的疗效及预后分析

doi:10.11958/20253703

天津医药 ›› 2026, Vol. 54 ›› Issue (10): 1024-1029.doi: 10.11958/20253703

经皮脊柱内镜手术与传统后路椎板切除术对胸椎黄韧带骨化症的疗效及预后分析

崔恩龙(), 丁林^△(), 鲁玉州, 王雨

日照市中医医院脊柱骨科（邮编 276800）

收稿日期:2025-12-21 修回日期:2026-05-11 出版日期:2026-10-15 发布日期:2026-10-10
通讯作者: △E-mail：cel1116@163.com
作者简介:崔恩龙（1990），男，主治医师，主要从事脊柱、脊髓损伤方面研究。E-mail：hukongcui939@163.com
基金资助:
山东省医药卫生科技发展计划项目(20220623108)

Analysis of the efficacy and prognosis of percutaneous spinal endoscopic surgery versus traditional posterior laminectomy for thoracic ossification of the ligamentum flavum

CUI Enlong(), DING Lin^△(), LU Yuzhou, WANG Yu

Department of Spinal Orthopedics, Rizhao Hospital of Traditional Chinese Medicine, Rizhao 276800, China

Received:2025-12-21 Revised:2026-05-11 Published:2026-10-15 Online:2026-10-10
Contact: △E-mail：cel1116@163.com

崔恩龙, 丁林, 鲁玉州, 王雨. 经皮脊柱内镜手术与传统后路椎板切除术对胸椎黄韧带骨化症的疗效及预后分析[J]. 天津医药, 2026, 54(10): 1024-1029.

CUI Enlong, DING Lin, LU Yuzhou, WANG Yu. Analysis of the efficacy and prognosis of percutaneous spinal endoscopic surgery versus traditional posterior laminectomy for thoracic ossification of the ligamentum flavum[J]. Tianjin Medical Journal, 2026, 54(10): 1024-1029.

摘要/Abstract

摘要：

目的对比经皮脊柱内镜手术与传统后路椎板切除术治疗胸椎黄韧带骨化症（TOLF）的临床疗效，并分析预后影响因素。方法回顾性收集167例TOLF患者的临床资料，根据患者的病情和治疗意愿所确定的手术方法将其分为对照组（54例，采用传统后路椎板切除术治疗）和观察组（113例，采用经皮脊柱内镜手术治疗）。对比2组手术指标、疗效及并发症发生率。随访6个月，依据日本骨科协会评估量表（JOA）评分改善率将患者分为预后良好组与预后不良组，对2组间各项指标进行单因素分析，筛选出具有统计学差异的指标，进一步纳入多因素Logistic回归分析筛选TOLF患者预后不良的影响因素。结果观察组术中出血量少于对照组，住院时间、手术时间、下地行走时间均短于对照组，术后Oswestry功能障碍指数（ODI）和数字评定量表（NRS）评分低于对照组，JOA评分高于对照组（P<0.05）。2组并发症发生率差异无统计学意义（P>0.05）；167例患者中预后良好组为116例（69.5%），预后不良组为51例（30.5%）。多因素Logistic回归分析发现，术前T2加权像髓内高信号（OR=4.667，95%CI：2.075~10.497）及术后脑脊液漏（OR=6.738，95%CI：2.625~17.295）是影响TOLF患者预后不良的独立危险因素，术前胸椎管面积残余率>80%（OR=0.421，95%CI：0.189~0.936）是影响TOLF患者预后不良的独立保护因素。结论经皮脊柱内镜治疗TOLF的疗效优于传统后路椎板切除术，术前T2加权像髓内高信号、术前胸椎管面积残余率及术后脑脊液漏是TOLF患者预后的影响因素。

关键词: 内窥镜检查, 预后, 胸椎, 黄韧带骨化症, 疗效, 影响因素

Abstract:

Objective To compare the clinical efficacy of percutaneous spinal endoscopic surgery and traditional posterior laminectomy in the treatment of thoracic ossification of the ligamentum flavum (TOLF), and to analyze prognostic influencing factors. Methods A retrospective analysis was conducted on the clinical data of 167 patients with TOLF who were treated in the spinal orthopedics department of our hospital from January 2017 to December 2023. The patients were divided into the control group (n=54) and the observation group (n=113) based on their own condition and treatment willingness to undergo surgery. The control group received traditional posterior laminectomy surgery, while the observation group underwent percutaneous spinal endoscopic surgery. The surgical indicators, therapeutic effects and complication rates of the two groups were compared. The patients were followed up for 6 months, and the Japanese Orthopedic Association Assessment Scale (JOA) score improvement rate was used to classify them into the favorable prognosis group and the unfavorable prognosis group. Univariate analysis was conducted on the indicators between the two groups to identify the statistically significant ones, and then multiple-factor Logistic regression analysis was further conducted to screen influencing factors for unfavorable prognosis in TOLF patients. Results The bleeding volume was less in the observation group than that in the control group. The hospitalization time, operation time and time to start walking after surgery were all shorter in the observation group than those in the control group. The postoperative Oswestry Disability Index (ODI) and Numerical Rating Scale (NRS) scores were lower in the observation group than those in the control group, while the JOA score was higher in the observation group (P<0.05). There was no significant difference in the incidence of complications between the two groups (P>0.05). Based on the JOA score improvement rate at 6 months postoperatively, in 167 patients, 116 cases (69.5%) were in the favorable prognosis group and 51 cases (30.5%) were in the unfavorable prognosis group. The multivariate Logistic regression analysis revealed that the intramedullary high signal on the preoperative T2-weighted image (OR=4.667, 95%CI: 2.075-10.497, P<0.001) and postoperative cerebrospinal fluid leakage (OR=6.738, 95%CI: 2.625-17.295, P<0.001) were independent risk factors affecting the prognosis of TOLF patients, while the preoperative residual rate of thoracic spinal canal area>80% (OR=0.421, 95%CI: 0.189-0.936, P=0.034) was an independent protective factor for the prognosis of TOLF patients. Conclusion The therapeutic effect of percutaneous spinal endoscopic treatment for TOLF is superior to that of traditional posterior laminectomy. Preoperative intramedullary high signal on T2-weighted images, preoperative residual rate of the thoracic spinal canal area and cerebrospinal fluid leakage are prognostic factors for patients with TOLF.

Key words: endoscopy, prognosis, thoracic vertebrae, ossification of the ligamentum flavum, therapeutic effect, influencing factors

中图分类号:

R681.5

图/表 7

参考文献 17

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组别		n	年龄/岁		性别
组别		n	年龄/岁		男		女
对照组		54	51.80±3.42		30（55.6）		24（44.4）
观察组		113	51.25±3.59		69（61.1）		44（38.9）
t或χ²			0.937		0.459
组别	病程/年			骨化分型
组别	病程/年			孤立型		连续型		跳跃型
对照组	4.29±1.08			15（27.8）		20（37.0）		19（35.2）
观察组	4.19±0.83			35（31.0）		43（38.1）		35（31.0）
t或χ²	0.639			0.335

组别		n	年龄/岁		性别
组别		n	年龄/岁		男		女
对照组		54	51.80±3.42		30（55.6）		24（44.4）
观察组		113	51.25±3.59		69（61.1）		44（38.9）
t或χ²			0.937		0.459
组别	病程/年			骨化分型
组别	病程/年			孤立型		连续型		跳跃型
对照组	4.29±1.08			15（27.8）		20（37.0）		19（35.2）
观察组	4.19±0.83			35（31.0）		43（38.1）		35（31.0）
t或χ²	0.639			0.335

组别	n	术中出血量/mL	住院时间/d	手术时间/min	下地行走时间/d
对照组	54	163.00±47.23	7.16±0.51	96.06±20.27	4.87±0.34
观察组	113	109.00±30.18	5.37±0.33	89.24±18.95	2.42±0.50
t		8.935^＊＊	27.166^＊＊	2.126^＊	32.709^＊＊

组别	n	术中出血量/mL	住院时间/d	手术时间/min	下地行走时间/d
对照组	54	163.00±47.23	7.16±0.51	96.06±20.27	4.87±0.34
观察组	113	109.00±30.18	5.37±0.33	89.24±18.95	2.42±0.50
t		8.935^＊＊	27.166^＊＊	2.126^＊	32.709^＊＊

组别	n			JOA评分
组别	n			术前			术后			t
对照组	54			5.17±0.58			7.52±0.50			22.551^＊＊
观察组	113			5.23±0.44			8.71±0.46			58.114^＊＊
t				0.783			15.215^＊＊
组别		ODI评分
组别		术前			术后				t
对照组		24.57±3.31			12.61±2.24				21.990^＊＊
观察组		24.70±4.06			10.39±2.06				33.412^＊＊
t		0.197			6.334^＊＊
组别			NRS评分
组别			术前			术后		t
对照组			6.52±0.50			2.89±0.42		40.850^＊＊
观察组			6.43±0.52			2.36±0.48		61.137^＊＊
t			1.002			6.860^＊＊

经皮脊柱内镜手术与传统后路椎板切除术对胸椎黄韧带骨化症的疗效及预后分析

Analysis of the efficacy and prognosis of percutaneous spinal endoscopic surgery versus traditional posterior laminectomy for thoracic ossification of the ligamentum flavum

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组别	n		年龄/岁	性别			病程/年		骨化分型					术前T2WI髓内信号				术前胸椎管面积残余率
组别	n		年龄/岁	男性	女性		病程/年		孤立型		连续型		跳跃型	高信号		中低信号		≤80%		>80%
预后良好组	116		51.19±3.68	69（59.5）	47（40.5）		4.05±0.80		35（30.2）		43（37.1）		38（32.8）	40（34.5）		76（65.5）		47（40.5）		69（59.5）
预后不良组	51		51.58±3.12	30（58.8）	21（41.2）		4.62±0.75		15（29.4）		20（39.2）		16（31.4）	36（70.6）		15（29.4）		32（62.8）		19（37.2）
t或χ²			0.659	0.006			4.321^＊＊		0.071					18.622^＊＊				7.022^＊＊
组别		术中出血量/mL		住院时间/d		手术时间/min		下地行走时间/d		术前JOA 评分/分		术前 ODI/分			术前NRS 评分/分		手术方式			术后脑脊液漏
组别		术中出血量/mL		住院时间/d		手术时间/min		下地行走时间/d		术前JOA 评分/分		术前 ODI/分			术前NRS 评分/分		传统后路椎板切除术		经皮脊柱内镜手术	术后脑脊液漏
预后良好组		120.35±40.18		5.82±0.79		89.58±19.24		2.89±0.88		5.30±0.46		24.67±4.08			6.43±0.52		34（29.3）		82（70.7）	10（8.6）
预后不良组		125.47±38.52		5.98±0.87		90.87±19.62		3.02±0.95		5.03±0.31		24.78±4.05			6.49±0.51		20（39.2）		31（60.8）	22（43.1）
t或χ²		0.768		1.168		0.397		0.858		3.824^＊＊		0.161			0.691		1.589			27.247^＊＊

变量	β	SE	Wald χ²	P	OR	OR（95%CI）
病程	0.289	0.219	1.739	0.187	1.335	0.896~2.050
术前T2WI髓内信号	1.540	0.414	13.872	<0.001	4.667	2.075~10.497
术前胸椎管面积残余率	-0.866	0.408	4.506	0.034	0.421	0.189~0.936
术前JOA评分	-0.539	0.443	1.477	0.224	0.583	0.245~1.391
术后脑脊液漏	1.908	0.481	15.736	<0.001	6.738	2.625~17.295
常数项	1.435	2.518	0.325	0.569	4.201

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