胸椎间盘突出合并胸椎黄韧带骨化症的手术治疗

Surgical treatment of TDH combined with OTLF

目的回顾性研究胸椎间盘突出症（TDH）合并胸椎黄韧带骨化症（OTLF）患者前后路一期手术的临床疗效.方法1999年1月～2005年12月收治5例TDH合并OTLF患者,其中男3例,女2例;年龄41～65岁,平均55岁.病程1～58个月,平均18个月.术前Frankel分级：B级1例,C级3例,D级1例.采用一期前路经胸胸椎侧前方椎间盘切除减压植骨内固定加后路全椎板切除椎管减压手术治疗.术后按JOA评分及Hirabayashi功能改善率评价手术疗效.结果随访6～50个月,平均20个月.术前JOA评分2～9分,平均5.1分;术后末次随访时5～10分,平均9.1分;平均功能改善率为78.9%.术后末次随访时Frankel分级：C级1例,D级4例.并发症：肺不张1例;双下肢肌力较术前下降1级1例.未发生严重并发症.结论在有条件的医院,一期经胸腔前后路手术是治疗TDH合并OTLF患者可行和疗效较好的治疗方法.

Objective To retrospectively study clinical effect of operation in treating thoracic disc herniation （TDH） combined with ossification of thoracic ligamentum flavum （OTLF） by anterior and posterior approach at first stage. Methods Five patients of TDH combined OTLF were treated from January 1999 to December 2005, including 3 males and 2 females. The mean age was 55 （range from 41-65） and the mean course was 18 months （range from 1-58 months）. There were 1 of Grade B, 3 of Grade C and 1 of Grade D according to Frankel grade system before operation. The operative methods were disc resection and internal fixation plus bone graft by anterior approach via the lateral and anterior of thoracic vertebrae combined with full-laminectomy for canal decompression by posterior approach at first stage. According to JOA score and improvement rate of Hirabayashi, to evaluate the operative effect. Results The follow-up period ranged from 6-50 months （ mean 20 months）. JOA score was 2-9 （ mean 5.1 ） preoperatively, and 5-10 （ mean 9.1 ） at the final follow-up postoperatively. The mean improvement rate was 78.9%. There were 1 of Grade C and 4 of Grade D according to Frankel grade system at the final follow-up postoperatively. Postoperative complications included atelectasis in 1 and muscle power of lower limbs declining by one grade compared to the preoperative in 1. No serious complication occurred. Conclusion In the well-conditioned hospital, operation at first stage by anterior and posterior approach via thoracic cavity is a practical and effective method for treating TDH combined with OTLF.