胸椎管狭窄症的诊断和治疗

Diagnosis and treatment of thoracic spinal stenosis

目的: 总结胸椎管狭窄症的临床特点, 加强对胸椎管狭窄症临床特点的认识。方法: 回顾总结获随访 120例经过手术治疗的胸椎管狭窄症患者的临床资料。98例行椎管后壁切除术, 侧前方入路行胸椎间盘或胸椎后纵韧带骨化病灶切除 17例 (其中经胸腔入路 7例, 经胸膜外或胸腹膜外 10例), 后路环椎管减压术 5例。随访时间最长 64个月, 最短 3个月, 平均 28个月。结果: 功能评定采用改良的Epstein评分标准, 优 51例, 良 42例, 改善 17例, 差 10例。优良率为 77. 5%。结论: 退变性胸椎管狭窄症症状复杂多样, 手术治疗是唯一选择。根据胸椎管狭窄症的不同病理改变选择手术方式, 可获得满意的效果。

Objective: To summarize characteristics of diagnosis and surgical treatment of thoracic spinal stenosis,and to deepen the knowledge of the thoracic spinal stenosis.Method:The underlying causes and surgical results were analyzed retrospectively in 120 cases of thoracic spinal stenosis which caused myelopathy. The operative procedure in 98 cases with predominant posterior compression of the neural elements consisted of decompression the posterior wall of the thoracic spinal canal at all affected levels. 17 cases underwent anterior decompression of the thoracic canal due to the predominance of anterior pathology, in which 7 cases had transthoracic discectomy and 10 cases had anterior extrapleural or retroperitoneal discectomy. Circles spinal canal decompression in 5 cases. 120 cases were followed up from 3 to 64 months with an average of 28 months.Result:There were neurological improvement in 110 patients, in which Epstein grade changed form preoperatively to postoperatively,10 patients showed no significant change or deteriorated after operation.Conclusion:Chronic severe myelopathy caused by thoracic spinal stenosis can be reversible with appropriate decompression. The choice of surgical approach depends on the site of the compressive lesion, its level and the patients' pathological features.