胸椎间盘突出症的手术治疗  

Surgical treatment of thoracic disc herniation

作　　者：缪志和 李铭 冯大鹏[2] 肖建如[2] 

机构地区：[1]解放军第515医院骨科,江苏江阴214431 [2]第二军医大学附属长征医院骨科,上海200003

出　　处：《临床骨科杂志》2010年第3期273-275,共3页Journal of Clinical Orthopaedics

摘　　要：目的探讨胸腰椎间盘突出症(TDH)的临床表现、诊断及手术治疗方法及效果。方法经后路手术治疗TDH患者24例,采用后路全椎板切除,经一侧或两侧关节突和下位横突进入切除突出椎间盘,其中15例采用后路椎间植骨融合双侧钉棒系统内固定,9例采用后路椎间植骨融合单侧钉棒系统内固定。结果随访1～8年,23例脊髓神经功能均有不同程度改善,1例T10～11巨大椎间盘突出者神经功能无改善。1例T8～9椎间盘突出合并后纵韧带骨化者术后症状加重,经对症治疗后1例神经症状加重者术后26个月神经功能恢复至D级。按Otanietal方法评价疗效:优16例,良8例,优良率达91.6%。结论 CT或MRI检查对TDH确诊与定位有重要价值。后路经关节突和下位横突(单或双侧)入路切除胸椎间盘可获得满意疗效。Objective To investigate the clinical manifestation,diagnosis,surgical treatment and clinical effect of thoracic disc herniation（TDH）.Methods 24 cases of TDH were undergone posterior surgery with total laminectomy and discectomy through unilateral/bilateral facet and transverse processes,of which 15 were performed posterior interbody fusion（PLIF）and bilateral rod-screw system fixation and 9 were performed PLIF and unilateral rod-screw system fixation.Results All cases were followed up for 1~8 years.The neural function improved in 23 cases by deferent degree,while one case with huge disc herniation at T10~11 got no improvement and one case with T8~9 TDH with ossification of posterior longitudinal ligament got exacerbation.All cases got symptom management（or symptomatic control）.Fellow-ups of 26 months revealed that the neural function of one case whose neural symptoms exacerbated after operation recovered to Grade D.Excellent results were obtained in 16,good in 8 according to Otani et al Evaluation.Excellent and good results were obtained in 91.6% of the patients.Conclusions CT or MRI is valuable for the diagnosis of thoracic disc protrusion.Through unilateral or bilateral approaches,TDH can be resected with satisfactory effect.

关 键 词：胸椎间盘突出 椎板切除术 椎间盘切除术 

分 类 号：R681.531[医药卫生—骨科学] R687.3[医药卫生—外科学]