经关节突入路治疗腹背侧压迫型胸椎管狭窄症  

Trans-facet joint approach to treat thoracic spinal stenosis due to anterior and posterior compression

作　　者：刘法敬[1] 申勇[1] 丁文元[1] 杨大龙[1] 徐佳欣[1] 杜伟[1] 

机构地区：[1]河北医科大学第三医院脊柱外科,石家庄050051

出　　处：《中国矫形外科杂志》2011年第11期881-884,共4页Orthopedic Journal of China

摘　　要：[目的]探讨经关节突入路行全椎板切除减压椎间融合内固定治疗腹背侧压迫型胸椎管狭窄症的临床效果和手术安全性。[方法]回顾性分析2006年5月～2009年3月在本院行关节突切除椎板减压植骨融合内固定术治疗的19例单节段腹背侧压迫型胸椎管狭窄症患者,男5例,女14例;年龄45～70岁,平均59.1岁;病程为10～52个月,平均20个月;胸椎间盘突出症(thoracic disc herniation,TDH)合并黄韧带骨化(ossification of the ligamentum fla-vum,OLF)11例,胸椎后纵韧带骨化(ossification of posterior longitudinal ligament,OPLL)合并胸椎OLF 8例。病变位于T4、51例,T5、61例,T6、73例,T8、92例,T9、103例,T10、116例,T11、123例。根据日本骨科协会(JOA)评分及Frankel分级评价神经减压效果。[结果]手术时间150～270 min,平均195 min;术中出血量500～1 300 ml,平均785ml。2例患者黄韧带与硬脊膜粘连骨化,行"漂浮法";4例术中发生脑脊液漏,经修补后愈合良好;1例患者发生伤口感染,加强伤口换药,应用敏感抗生素后愈合;1例术后出现神经功能症状加重,给予甲强龙冲击,3个月肌力恢复至术前水平。术后随访12～26个月,平均16个月,随访期间未出现脊柱不稳及内固定物松动、断裂等情况。术后3个月及末次随访时JOA评分均较术前明显恢复(P<0.05),优良率为71.43%;末次随访时Frankel分级:A级1例,B级4例,C级5例,D级6例,E级3例。[结论]经关节突入路减压融合内固定术治疗腹背侧压迫型胸椎管狭窄症,彻底减压的同时给予坚强固定,患者可获得满意的疗效。[ Objective ] To investigate the clinical outcomes and surgical safety of trans -facet joints approach to treat thoracic spinal stenosis due to anterior and posterior compression. [ Methods ] A retrospective analysis was performed in 19 patients who had anterior and posterior compression of thoracic spinal stenosis and received trans - facet joint approach combined with total laminectomy decompression, interbody fusion and internal fixation operation between May ：2006 and March 2009. There were 5 male and 14 female patients ranging from 45 - 70 years （mean, 59. 1 years） . The disease course was 10 -52 months （ average, 20 months） . There were 11 patients with thoracic disc herniation （TDH） and ossification of the ligamentum flavum （OLF）, and 8 patients with ossification of posterior longitudinal ligament （OPLL） and OLF. The lesion segments were T4,5 in 1 , T5,6 in 1, T6,7 in 3, T8,9 in 2, T9,10 in 3, T10,11 in 6, and T11,12 in 3 patients. The postoperative curative effect was measured by JOA score and Frankel score system. [Results] The operation time was 150 -270min （mean, 195 min） , with an averaged blood loss of 785 ml. Flotation method was performed in 2 patients due to epidural adhesions with OLF. Cerebrospinal fluid leakage occurring in 4 patients, and healed well after repair. There was one patient with wound infection and one patient with neurological symptom deterioration, but they recovered to preoperative level after methylprednisolone treatment. All patients followed up for 12 -26 months （mean, 16 months） and the symp- toms were improved at different degrees without spinal instability and internal fixation loosing occurring. The JOA score had a significant recovery at 3 months and at the last follow - up compared with preoperation （P 〈 0. 05 ） . Based on Frankel score system at last follow - up, there was A in one, B in 4, C in 5, D in 6, and E in 3 patients. [ Conclusion] The trans - facet joint approach is feasible in treating thoracic spinal stenosis due to anter

关 键 词：胸椎 椎管狭窄 经关节突入路 脊髓压迫症 

分 类 号：R687.3[医药卫生—骨科学]