椎板分层摘除法治疗胸椎管狭窄症  

cLaminate and remove vertebral plate to treat thoracic spinal canal stenosis

作　　者：胡海升[1] 杨利民[1] 林勇[1] 林海东 赵海龙 

机构地区：[1]青岛市市立医院骨科,266011 [2]栖霞市人民医院骨科 [3]青岛市黄岛开发区医院骨科

出　　处：《中华骨科杂志》2007年第2期86-89,共4页Chinese Journal of Orthopaedics

摘　　要：目的探讨胸椎管狭窄症的手术方法及手术安全性。方法23例胸椎管狭窄症患者，男11例，女12例；年龄40-78岁，平均56岁。临床表现：双下肢无力17例，行走困难23例，损伤平面以下感觉减退13例，锥体束受损表现13例，括约肌功能障碍5例。患者术前均行X线和MR检查，部分患者行CT扫描检查。病变累及上胸段4例，中胸段4例，下胸段15例。手术采用后方入路，椎板分层摘除法完成全椎板减压，部分患者同时行椎间盘摘除或植骨内固定术。下肢功能评定采用Mann标准，术前Ⅲ级9例，Ⅳ级10例，V级4例。脊髓功能评定采用截瘫指数，术前截瘫指数1分4例，2分12例，3分4例，4分3例。结果23例患者术后无一例症状加重。平均手术时间为150min，平均出血量为425ml。术后21例患者脊髓功能不同程度提高，提高1级13例，提高2级7例，提高3级1例，术后改善率为91．3％（21／23）。术后截瘫指数0分5例，1分8例，2分6例，3分4例。术后20例获得随访，随访时间5个月~5年，平均25．2个月。末次随访时下肢功能Ⅰ级10例，Ⅱ级6例，Ⅲ级3例，Ⅴ级1例，优良率80％（16／20）。末次随访时截瘫指数0分10例，1分7例，2分3例。结论椎板分层摘除法是一种安全有效的手术方法，适合于需要全椎板减压的胸椎管狭窄症患者。Objective To discuss the method and safety of operation in treatment of thoracic spinal stenosis. Methods 23 cases of thoracic spinal stenosis were included in the study, male 11 cases, female 12 cases, the range of age from 40 to 78 years（mean age 56 years）. The clinical presentation included weakness of lower limbs in 17 cases, ambulation dysfunction in 23 cases, paraparesis in 13, pyramidal sign in 13 and urinary incontinence in 5 cases. All cases accept magnetic resonance imaging and X-ray image, some cases accept computerized tomography. Pathological changes involved upper thoracic spine in 4 cases, middle thoracic spine in 4 and lower thoracic spine in 15. Dorsal approach was advocated in decompression. Laminate and remove vertebral plate were used in all of these cases, some cases underwent discectomy or bone graft with internal fixation. Lower limb function results were evaluated using Mann classification, the preoperative Mann grade were grade Ⅲ in 9 cases, grade Ⅳ in 10 cases and grade Ⅴin 4 cases. Spinal cord function results were evaluated by paraplegia index, the preoperative paraplegia index were 1 in 4 cases, 2 i n 12 cases, 3 in 4 cases and 4 in 3 cases. Results Laminate and remove vertebral plate were used in all of these 23 cases, the symptom did not get worse after operation. The average operative time was 150 minutes and the average amount of blood bless was 425 ml. The spinal cord function got better in 21 cases, 13 eases improved by 1 grade, 7 eases improved by 2 grade, and 1 ease improved by 3 grade. According to Mann classification, the lower limb function relief rate was 91.3%（21/23） after operation. After operation, paraplegia index was 0 in 5 eases, 1 in 8 eases, 2 in 6 eases and 3 in 4 eases. 20 eases were followed-up from 5 month to 5 years, mean 25.2 month. At final follow up, the lower limb function was grade Ⅰ in 10 eases, gradeⅡ in 6 eases, grade Ⅲ in 3 eases and grade Ⅴ in 1 ease, the excellent rate was 80%（16/20）. Paraplegia index at final follow up was

关 键 词：胸椎 椎管狭窄 减压术 外科 

分 类 号：R686[医药卫生—骨科学]