胸椎管狭窄症的手术治疗

Surgical treatment of thoracic spinal stenosis

目的探讨和评价胸椎管狭窄症的手术方法及临床疗效。方法回顾分析我院手术治疗的胸椎管狭窄症29例临床资料,手术方式包括经后路减压手术21例(其中9例使用了椎弓根内固定及后路植骨融合),侧前方入路减压、植骨融合、钢板固定术8例。随访时间最长60个月,最短4个月,平均32个月。结果功能评定采用JOA评分标准:优14例,良10例,好转3例,无效1例,较术前症状加重1例。结论胸椎管狭窄症一经确诊,手术治疗是唯一的选择;根据受压情况选择后路或侧前方入路,通过精湛的手术技术和仔细的操作,可以获得令人满意的临床效果。

Objective To study and evaluate the surgical methods and clinical curative efficacy of thoracic spinal stenosis.Methods A retrospective analysis was adopted to investigate the results of operative treatment of symptomatic thoracic spinal stenosis.The operative procedures included posterior decompression and anterolateral decompression.The operative procedure in 21 cases of predominant posterior compression consisted of decompression of the posterior wall of the thoracic spinal canal.9 cases underwent lateral mass of vertebrae interfixation and bone graft to fuse posteriorly.8 cases underwent anterolateral canal decompression.29 cases were followed up from 4 to 60 months with an average of 32 months.Results There were neurological improvement in 27 patients in which JOA grade changed before and after surgery.2 patients showed no significant change or deteriorated after operation.Conclusion Thoracic spinal stenosis is final diagnosis.It is no other choice but surgical treatment.The option of surgical approach depends on the site of compressive lesion.Satisfactory results may be gained with good surgical management and careful procedures.