下胸椎椎管狭窄症的临床和治疗特点

Analysis of the clinical character of lower thoracic spinal stenosis and safety of the surgery

目的探讨下胸椎椎管狭窄症的发病机制、病理、临床表现及治疗的特点。方法回顾性分析自1986年6月至2005年9月收治的37例下胸椎椎管狭窄症患者，其中韧带骨化29例：16例黄韧带骨化（ossification of ligamentum flavum，OLF）、13例后纵韧带骨化（ossification of posterior longitudinal ligament，OPLL）；椎间盘突出症8例（Scheuermann病或非典型Scheuermann病）；病变部位：T10.11间隙12例，T11．12间隙14例，T12L1间隙11例。观察病变节段和临床神经定位体征间的关系，评价并总结其病理特征和术后神经功能恢复情况。手术采用后路减压或经肋横突入路减压治疗，严格遵循“安全手术原则”。结果下胸椎T10．11、T11.12、T12L1病变间隙导致相应脊髓节段和神经功能不同程度的障碍，神经定位检查具有特异性：T12L1椎间病变患者不出现跟腱反射或膝反射亢进，无髌阵挛或踝阵挛，可出现Babinski征；T11．12椎间病变不出现膝反射亢进或髌阵挛，可出现跟腱反射亢进或踝阵挛及Babinski征阳性，而在T10.11椎间病变上述体征均可能出现。21例患者获完全随访，根据改良JOA评分标准，21例效果均为优良。结论下胸椎椎管狭窄症的病因多是韧带骨化或椎间盘硬突出，引起“一元化”脊髓病变，不同间隙病变有特异性表现，多数采用后路减压术可解除压迫，但应注意安全手术原则。

Objective To observe the pathogenesis, pathology, clinical characters and treatment of the lower thoracic spinal stenosis. Methods From June 1986 to September 2005, 37 cases of lower thoracic spinal stenosis were treated surgically. There were 21 male and 16 female with an average age of 56 years. Among the patients, there were 29 cases ligament ossification, which includes OFL 16 cases, OPLL 13 cases; thoracic vertebral disc protrusion 8 cases （Scheuermann disease and atypical Scheuermann disease）. The pathological location was T10.11 12 cases,T11.12 14 cases,T12L1 11 cases. Analysis the spinal cord injury site and clinical location neural physical sign and summarize the pathological characteristics, surgery method and improvement of lower extremity function after surgery. Results Spinal stenosis of lower thoracic T10.11 ,T11.12, T12L1 intervertebral space lead to special clinical nerve location manifestation. All the patients were operated by posterior laminar decompression or intervertebral disc excision from rib-process transverses approach. And 21 cases were followed for 1 to 19 years and the outcome was good according to the modified JOA score. Conclusion Pathogenesis of lower thoracic spinal stenosis were mostly ligament ossification and in- tervertebral disc hard protrusion which induce spinal cord injury. Usually only one intervertebral stenosis leads to the characteristic clinical neural manifestation. Posterior vertebral decompression was usually selected to treat this disorder and minimally invasive operation principles should be paid attention.