手术治疗胸椎管狭窄症的效果分析

Surgical treatment for thoracic spinal stenosis

目的:探讨胸椎管狭窄症患者手术治疗的近期疗效。方法:2003年3月～2009年6月手术治疗胸椎管狭窄症患者21例,其中后路椎板切除减压术16例,经胸膜外或腹膜后侧前方入路椎间盘切除或椎体次全切除、植骨融合固定术4例,经胸腔侧前方入路椎体次全切除椎间植骨融合前路钢板固定术1例。观察并发症发生情况,记录术前、术后2周和末次随访时的神经功能Frankel分级及胸椎JOA评分,测量手术节段后凸Cobb角。结果:平均手术时间156min,平均术中出血量280ml,术中无血管损伤。6例发生术后并发症,其中单纯脑脊液漏2例,神经根损伤并脑脊液漏1例,硬膜外血肿1例,一过性神经功能损伤加重2例,均经处理后治愈。随访6～75个月,平均21个月,术后2周Frankel分级10例改善、11例无变化,末次随访时Frankel分级13例改善、8例无变化。术后2周、末次随访时JOA评分较术前改善(P<0.05),术后2周和末次随访时的平均改善率分别为42.8%、63.1%,优良率分别为28.6%、71.4%,总有效率均为85.8%。末次随访时多节段椎板切除减压患者手术节段后凸Cobb角较术前增加(P<0.05)。结论:对胸椎管狭窄症患者采用后路椎板切除减压为主的手术治疗可获得较好的近期效果,但手术并发症发生率较高,多节段椎板切除可导致后凸角明显增加。

Objective：To investigate the short-term clinical efficacy of different surgical approaches for thoracic spinal canal stenosis.Method：21 cases with thoracic spinal canal stenosis were treated surgically in our hospital from March 2003 to Jun 2009.Posterior laminectomy was performed in 16 cases,anterior subtotal corpectomy together with auto-graft fusion and fixation through extrapleural and/or retroperitoneal approach was performed in 4 cases,anterior approach transthoracically in 1 case.The complications,Frankel grade,JOA score and Cobb angle of kyphosis were measured at 2 weeks postoperatively and final followed up respectively.Result：The average operation time was 156min with blood loss of 280ml and no intraoperative vascular complications.Postoperative complications occurred in 6 cases,including cerebrospinal fluid leakage in 2 cases,nerve root injury combined with cerebrospinal fluid leakage in 1 case,epidural hematoma in 1 case,temporary neurological deficit in 2 cases,all recovered after effective intervention.All cases were followed up for a mean of 21 months（range,6-75 months）.Compared with preoperation,improvement of Frankel grade was noted in 10 cases and the rest 11 cases still remained no change two weeks after operation whereas improvement occurred in 13 cases and no change in 8 cases at final follow-up.The mean preoperative JOA score improved at 2 weeks after operation and till the final followed up（P0.05）,with the average recovery rate of 42.8% and 63.1% at 2 weeks and final follow-up respectively.The excellent and good rate was 28.6% and 71.4% at 2 weeks and final follow-up respectively.Both were noted to have the effective rates of 85.8%.Compared with preoperation,multi-segment laminectomy tended to have Cobb degree increased more（P0.05）.Conclusion：Surgical treatments especially posterior decompressive laminectomy shows a good clinical outcome for thoracic spinal stenosis.However,the incidence of surgical related complications is still high and posterior multi-segment laminectomy can notably result in increasing of kyphosis.