胸椎间盘突出症的手术治疗

The clinical effect observation of thoracic discectomy

目的:探讨胸椎间盘突出症的手术治疗方法及疗效.方法:29例胸椎间盘突出症患者,术前均有不同程度的感觉及/或运动障碍,合并后纵韧带骨化者16例,合并黄韧带骨化和肥厚者13例.病变部位主要在下胸段(68.3%),上胸段次之(19.5%),中胸段最少(12.2%).采用后路全椎板截骨、经一侧或两侧关节突和下位横突进入切除突出椎间盘、椎板再植椎管成形术,共切除突出椎间盘41个,9例加用后路椎间植骨融合钉棒系统内固定.结果:5例出现并发症,其中运动障碍加重2例,脑脊液漏3例.所有患者术后即有感觉恢复,运动功能6个月以内恢复较快,24个月后无明显恢复.24例患者术后获得随访,随访时间7～62个月,平均19个月.疗效评价参照Epstein标准,优11例,良9例,改善2例,差2例,优良率83.33%,总有效率91.67%.术后CT及MRI显示椎板融合成形良好,手术减压满意.结论:胸椎间盘突出症发病部位以下胸段为多,如出现症状多需手术治疗,切除突出的椎间盘可获得满意疗效.

Objective: To introduce a new procedure and evaluate the clinical effect of thoracic discectomy.Method:29 cases were studied.16 patients were associated with OPLL,while 13 cases with ossification of the yellow ligament.The affected levels were mainly at lower thoracic(68.3%),while 19.5% at upper thoracic and 12.2% at the middle.All patients underwent total laminectomy and discectomy(41 segments) through costotransversectomy.9 cases needed internal fixation.Result:24 patients were followed up from 7~62 months (mean 19 months).According to Epstein grade,there were 11 excellent cases,9 good,2 improved and 2 poor.The excellent and good rate was 83.33% and effective rate was 91.67%.Postoperative complication occurred in 5 cases,including exacerbation of pre-existing deficits in 2 cases,CSF leakage in 3 cases.The other patients achieved obvious neurological improvement.CT showed the decompression and fusion of the replanted laminae were satisfied.Conclusion:The thoracic disc herniation often affects the lower thoracic spine,most of time surgery are needed.Our new surgery procedure can improve the clinical result obviously.