胸椎管狭窄症的微创手术治疗新进展  

New progress in minimally invasive surgical treatment of thoracic spinal stenosis

作　　者：杨帆 安晓龙 周程沛 朱凯龙 钱济先 钱澍 YANG Fan;AN Xiaolong;ZHOU Chengpei;ZHU Kailong;QIAN Jixian;QIAN Shu(Department of Orthopedics,the Second Affiliated Hospital of Air Force Military Medical University,Xi'an,Shaanxi 710038,China;不详)

机构地区：[1]空军军医大学第二附属医院骨科,陕西西安710038 [2]延安市人民医院骨科,陕西延安716000

出　　处：《中华全科医学》2024年第2期292-295,300,共5页Chinese Journal of General Practice

基　　金：国家自然科学基金项目(81871818)。

摘　　要：胸椎管狭窄症是由一种或多种病理性的致病因素导致胸段椎管有效横截面积减少,相应层面脊髓或神经根受压而引起的一组临床综合征。其致病因素包括黄韧带骨化、后纵韧带骨化、胸椎间盘突出、椎体后缘骨赘及椎小关节增生等。患者多表现为双下肢麻木无力、行走困难。在人群中其发病率相比于颈椎管狭窄、腰椎管狭窄低,但若诊治不及时,预后往往不良,给患者日常生活造成极大负担。传统的治疗方式以胸椎后正中入路全椎板切除术为主,但存在后柱稳定性结构破坏大、出血量多、术后恢复期长等不足。近年来,随着微创技术在腰椎疾病方面的发展,学者们也不断探索微创技术在胸椎管狭窄症方面的应用及可行性,取得了突破性的进展,从较早期的显微内镜下减压技术,到显微镜辅助下减压,再到经皮内镜、单侧双通道内镜技术在胸椎疾病方面的初步探索应用,以及脊柱导航辅助技术及机器人辅助技术的出现。这些技术的发展及应用,均较大程度地提高了胸椎管狭窄症的治疗效果,减少了手术创伤和并发症的发生,加快了患者康复。尤其是近3年来,经皮内镜和单侧双通道内镜技术的迅猛发展,国内外学者在胸椎管狭窄症的治疗上进行了诸多的探索,显示出一些优势。本文就该疾病的微创手术治疗研究现状进行综述。Thoracic spinal stenosis is a group of clinical syndromes caused by a reduction in the effective cross-sectional area of the thoracic spinal canal.This reduction leads to compression of the spinal cord or nerve roots at the corresponding level due to various pathogenic factors including ossification of the ligament flavum,ossification of the posterior longitudinal ligament,thoracic disc herniation,osteophyte formation at the posterior edge of the vertebral body,and hyperplasia of the vertebral facet joint.Symptoms commonly observed in patients include lower limb numbness,weakness,and difficulty in walking.Although the incidence of thoracic spinal stenosis is lower compared with cervical and lumbar spinal stenosis,delayed diagnosis and treatment often result in a poor prognosis and significant burden on daily life.The traditional treatment method involves total laminectomy via a posterior median approach.However,this approach has drawbacks such as damage to the stability of the posterior column,increased bleeding,and a long postoperative recovery period.In recent years,chiropractors have been exploring the application and feasibility of minimally invasive techniques in the treatment of thoracic spinal stenosis,leading to significant advancements.These advancements include microendoscopic decompression technology,microscopes assisted decompression,percutaneous endoscopy,unilateral double-channel endoscopy in thoracic vertebral diseases,and the use of spinal navigation and robot assistance technologies.These techniques have improved the therapeutic efficacy of thoracic spinal stenosis,reduced trauma and complications,and enhanced the recovery of patients.Notably,percutaneous endoscopy and unilateral biportal endoscopy technologies have shown promising outcomes in the treatment of thoracic spinal stenosis.This article provides a comprehensive review of the research on minimally invasive surgical treatment for thoracic spinal stenosis.

关 键 词：胸椎管狭窄症 微创手术 全脊柱内镜 显微内镜 单侧双通道内镜 

分 类 号：R681.5[医药卫生—骨科学] R616[医药卫生—外科学]