多椎板整块切除治疗胸椎管狭窄症

Multi-level en bloc laminectomy for the treatment of thoracic canal stenosis

目的探讨多椎板整块切除术治疗胸椎管狭窄症的疗效。方法回顾性总结1992年8月至2005年8月采用多椎板整块切除减压治疗75例胸椎管狭窄症患者的资料，其中男39例，女36例；年龄25-71岁，平均54．8岁。胸椎黄韧带肥厚、骨化60例；单纯后纵韧带骨化5例；椎板增厚内陷5例；多发性、跳跃性胸椎间盘突出5例。手术取后正中切口，常规显露需减压范围的棘突、椎板、小关节突。切除椎板的范围是头尾侧均需超过受累水平1个节段，两侧沿小关节突内缘椎板开槽呈矩形。采用日本整形外科协会（JOA）胸脊髓病评分法评定术前术后脊髓功能情况，评价治疗效果。结果75例患者共切除328个节段椎板，平均4．7个节段，其中3个节段24例，4个节段10例，5个节段17例，6个节段15例，7个节段5例，8个节段3例，12个节段1例。术中有硬膜撕裂或缺损的11例患者经修补硬膜和严密缝合各层组织术后未出现脑脊液漏；切口浅表感染3例，经换药愈合。随访时间10～32个月，平均28个月。JOA评分术前平均（4．027±1．838）分，随访时平均（8．347±2．555）分，术前和随访时比较差异有统计学意义（t=19．431，P=0．000〈0．01），其中优29例，良31例，改善11例，无变化4例，无加重病例，优良率为80．0％（60／75），总有效率为94．7％（71／75）。结论多椎板整块切除法治疗胸椎管狭窄症具有减压彻底、操作安全和疗效肯定等优点，值得临床推广应用。

To discuss the surgical results of multi-level en bloc laminectomy for the treatment of thoracic canal stenosis （TCS）. Methods All the 75 cases of TCS treated with muliti-level en bloc laminectomy from Auguest 1992 to Auguest 2005 were studied retrospectively, including 39 males and 36 females, with an average of 54.8 years old （ranged from 25 to 71 years old）. There were 60 patients with ossification of ligamentum flavum, 5 patients only with ossification of posterior longitudinal ligament, 5 patients only with lamina thickness and invagination, 5 patients only with muti-level thoracic disc herniation. Posterior laminectomy was performed in all patients. The Japanese Orthopaedics Association （JOA） standard were used to evaluate for all the 75 patients with thoracic myelopathy. Results A total of 328 laminae with an average of 4.7 （range, 3 to 12 laminae） were resected in 75 cases. 3 laminae were resected in 24 cases, 4 laminae in 10, 5 laminae in 17, 6 laminae in 15, 7 laminae in 5, 8 laminae in 3, and 12 laminae in 1. Intraoperative teared dura （11 patients） was repaired and postoperative cerebrospinal fluid leakage was not observed. Superficial wound infection （3 patients） was cured. The mean follow-up duration was 28 months （10 to 132 months）. The mean JOA score increased from 4.027±1.838 preoperatively to 8.347±2.555 during followed-up. The difference was significant （t=-19.431, P=-0.000〈 0.01）. There were excellent 29, good 31, improved 11, and unchanged 4. The excellent and good rate was 80.0%（60/75）, and the total effective rate was 94.7%（71/75）. Conclusion Multi-level en bloc laminectomy for the treatment of TCS has advantages of thorough decompression, safe manipulation, certainly effects, etc. It is worth to be used widely.