经后外侧入路治疗胸椎间盘突出症38例报告

Thoracic disc herniation treated with posterolateral transpedicular approach operation

目的评价采用后外侧入路治疗胸椎间盘突出症的疗效。方法自1999年11月至2003年11月间采用经小关节突后外侧入路治疗胸椎间盘突出症患者38例,男24例,女14例;年龄30.5～67.5岁,平均46.5岁。病程为5～12个月,平均9个月。突出节段以T9-10和T10-11为主,占45%。T8-9、T11-12、T12L1各4例,分别占11%。所有患者均行X线及MR检查,22例行脊髓造影,25例行CT或CTM检查。本组38例中有3例突出部分发生钙化,嵌入脊髓。MRI显示本组38例中合并胸椎黄韧带骨化(OLF)8例,后纵韧带骨化(OPLL)10例。22例行腰椎逆行造影,正位X线片显示蛛网膜下腔受压、完全梗阻者8例,不完全梗阻者6例,其中8例是由于黄韧带肥厚、骨化或后外侧小关节突增生所致;侧位X线片均表现为椎间隙相应水平硬膜囊前后径变窄,硬膜囊或脊髓受压。结果术后随访1.2～3.5年,平均2.8年。采用Otanni评分系统进行疗效评估,优16例,良18例,可2例,差2例。术后无一例出现脊柱不稳、神经症状加重及伤口感染等,优良率为89.47%。1例患者术后出现腰部束带感改善不明显,但双下肢肌力明显恢复(1级恢复为3级);1例术后大小便功能恢复不明显,无其他不适症状,行针灸对症治疗后12d恢复。无术中神经根损伤。结论采用后外侧入路治疗胸椎间盘突出症临床效果良好,并能减少并发症。

Objective To evaluate the clinical results and the value of usefulness with the operation methods of posterolateral transpedicular approach in treating thoracic disc herniation. Methods Selecting the patient who treated in our hospital from November 1999 to November 2003. In all the 45 patients who suffered from thoracic disc herniation, we had got 43 patients followed up, the following-up times were from 1.2 to 3.5 years. 38 patients were treated with posterolateral unilateral transpedicular approach operation method. There were 26 males and other 19 females. The patients were from 30.5 years old to 67.5 years old, and the mean age was 46.5 years old. The interval between onset of symptoms and operation ranged from 5 to 12 months, and 9 months for average. In this group, 45% patients were involved in T9-10 and T10-11 disc herniation, 4 cases（11%） in Ts8-9, 4 cases（11%） in T11-12, and 4 cases（ll%） in T11L1. All patients underwent X-ray and MR examination. 22 patients underwent myelography, 25 patients underwent CT or CTM examination. Using Otanni scored system to evaluate the clinical results. Selecting the SPSS 11.5 to do the statistics works. Results A perfect result was found in 16 patients, a good result was found in a further 18 patients, and a fair result was found in 2 patients the outcome was unchanged with no effect in 2 cases. No clinical or radiographic features of instability, nervous symptoms and wound infection were found. The clinical satisfaction rate was 89.74%, the results showed that it was a good result of posterolateral entrance operation. Conclusion The posterolateral transpedicular entrance operation shows a good result in treating patients who suffered from thoracic disc herniation.