胸椎管狭窄症的术式选择  

Surgical choice of thoracic spinal canal stenosis

作　　者：杨勇[1] 刘刚[1] 王建华[1] 苏义拉图[1] 张国梁[1] 赵建民[1] 霍洪军[2] 

机构地区：[1]内蒙古医学院附属医院骨科,呼和浩特010050 [2]内蒙古医学院第二附属医院

出　　处：《骨科》2010年第1期26-28,共3页ORTHOPAEDICS

摘　　要：目的探讨胸椎管狭窄症的手术方式。方法回顾分析1992年8月～2008年4月期间治疗的胸椎管狭窄症患者124例,使用传统椎板切除减压32例,前方经胸减压植骨内固定2例,后方加侧前方减压3例,多椎板整块切除法减压87例。采用日本矫形外科协会(JOA)胸脊髓病评分法,术前评分为(4.31±1.85)分。结果随访时间12～138个月,平均30个月,随访时JOA评分为(9.15±1.97)分,与术前比较差异有统计学意义(t=30.125,P=0.000),其中优49例,良52例,改善15例,无变化4例,加重4例,优良率为81.45%(101/124),总有效率为93.55%(116/124)。并发症:术中有硬膜撕裂或缺损的12例患者,均给予仔细修复,再加严密缝合切口各层组织,术后未形成脑脊液漏;皮肤浅表感染3例,经换药愈合。随访临床和X线片均未见胸椎不稳定表现。结论胸椎管狭窄症的后路减压效果满意,多椎板整块切除法具有减压彻底、操作安全和疗效肯定等优点,前路减压植骨内固定只适用于局限型OPLL和胸椎间盘突出症。Objective To discuss the surgical effects of thoracic spinal canal stenosis（TSCS）.Methods From Aug.1992 to Apr.2008,124 cases of TSCS were treated.Thirty-two patients received traditional laminectomy,87 muliti-level en bloc laminectomy,2 anterior approach,and 3 laminectomy plus anteriolateral decompression.There were 61 males and 63 females with age ranging from 25 to 72 years old（mean 56）.The Japanese Orthopaedics Association（JOA）standard was used to evaluate all the 124 patients with thoracic myelopathy.The mean JOA score was 4.31±1.85 preoperatively.Results The mean follow-up duration was 30 months（12 to 138 months）.The mean JOA score was 9.15±1.97 during the follow-up period,and the difference was significant（t=30.125,P=0.000）in comparison to the preoperative score.Excellent efficacy was obtained in 49 cases,good in 52,improved in 15,unchanged in 4,and aggravated in 4.The excellent and good rate was 81.45%（101/124）,and the total effective rate was 93.55%（116/124）.Intraoperative teared dura（12 patients）was repaired and postoperative cerebrospinal fluid leakage was not observed.Superficial wound infection（3 patients）was cured.Conclusion Multi-level en bloc laminectomy for treatment of TSCS has advantages of thorough decompression,safe manipulation and certainly effects,etc.Anterior decompression and internal fixation are only fit for patients with limited OPLL and thoracic disc herniation.

关 键 词：胸椎 椎管狭窄症 减压术 外科 

分 类 号：R687.3[医药卫生—骨科学]