角翼骨刀在经关节突入路治疗硬化性胸椎间盘突出症中的应用

Application of angle-wing osteotome in costotransversectomy approach for sclerosing thoracic disc herniation

目的:探讨自行设计的角翼骨刀在经关节突入路治疗硬化性胸椎间盘突出症的应用价值。方法:2006年8月至2008年6月收治16例硬化性胸椎间盘突出症患者,男11例,女5例;年龄26～61岁。单节段14例,双节段2例;中央型突出11个椎间盘,旁中央型突出7个椎间盘。均采用经关节突入路减压、植骨、内固定术,术中应用自行设计的角翼骨刀切除硬化性椎间盘。结果:16例患者均顺利完成手术,术后无脑脊液漏及及因术中牵拉导致脊髓损伤加重等并发症发生。术后X线片显示内固定位置良好,CT显示突出物切除彻底。随访8～31个月,平均16.3个月,神经功能均获得不同程度的恢复,末次随访时按Otani评分,优6例,良9例,可1例。均获得植骨融合,无内固定松动断裂等并发症发生。结论:角翼骨刀能在不牵拉脊髓的前提下对突出的硬化性胸椎间盘进行完整切除,有效避免了术中脊髓和硬膜损伤。

Objective：To evaluate the clinical application of self-designed angle-wing osteotome in costotransversectomy approach for sclerosing thoracic disc herniation.Method：From august 2006 to June 2008,16 patients with thoracic disc herniation were treated in our hospital.All patients underwent X-ray and CT or MRI examination at preoperation and postoperation,which showed severe sclerosing thoracic disc herniation and dural compression.All patients underwent costotransversectomy approach for sclerosing thoracic disc herniation by using self-designed angle-wing osteotome.Result：All 16 patients had successful operations,no cerebrospinal fluid leakage and neural symptoms deterioration were noted.X-ray showed no malposition of internal fixation,CT scan showed complete removal of compressor.All 16 patients were followed up for an average of 16.3 months（range,8 to 31 months）.All patients had neurofunction recovered to some extent,and at final follow-up according to Otani criterion,6 patients rated excellent,9 good and 1 fair.All got bony fusion without instrument failure.Conclusion：Angle-wing osteotome used in the surgery of sclerosing thoracic disc herniation can effectively remove the compressor as well as keeping spinal cord intact.