颈、胸、腰椎共存退行性病变的临床特点及手术治疗

Clinical features and surgical treatment of the coexistence of cervical,thoracic and lumber degenerative disease

目的 探讨颈、胸、腰椎共存退行性病变的临床特点及手术治疗方法.方法 2004年1月至2008年12月,手术治疗颈、胸、腰椎共存退行性病变患者79例,男51例,女28例;年龄30～80岁,平均58.1岁.79例患者均有颈、胸、腰椎同时受压的表现,如四肢麻木、无力,胸腹束带感,明显感觉减退平面,下肢痛,上、下肢病理征阳性等.其中41例以颈部症状为重,5例以胸椎症状为重,12例以腰椎症状为重.根据病变的严重程度,采用单纯颈椎手术41例,胸椎手术5例,腰椎手术12例;接受两部位手术21例.按日本骨科协会（Japanese Orthopaedic Association,JOA）评分评价术后疗效,并计算改善率.结果 采用不同手术方式,术后JOA评分均有不同程度的提高.单纯颈椎手术的改善率为66.06%±14.33%,单纯胸椎手术的改善率为56.19%±9.85%,单纯腰椎手术的改善率为63.49%±9.78%.21例行两部位手术,其中14例一期行两部位手术,改善率为76.78%±3.94%,7例分期行两部位手术,改善率为71.79%±8.74%.结论 颈、胸、腰椎共存退行性病变主要由椎间盘突出、椎管狭窄、后纵韧带及黄韧带肥厚或骨化等引起,为脊柱多部位发现,表现复杂,治疗时应根据患者症状及影像学表现等进行多方面综合判断,选择最佳的手术方案.

Objective To discuss clinical features and surgical treatment of the coexistence of cervical,thoracic and lumber degenerative disease.Methods From January 2004 to December 2008,79 cases with the coexistence of cervical,thoracic and lumber degenerative disease were surgically treated,including 51 males and 28 females,aged from 30 to 80 years（average,58.1 years）.All 79 cases presented coexistence of cervical,thoracic and lumbar compression symptoms,such as limb numbness,weakness,zonesthesia and positive Hoffmann and Babinski sign.Forty-one cases mainly presented cervical symptoms,5 presented thoracic symptoms and 12 presented lumbar symptoms.According to affected segments,41 cases received cervical operations,5 cases received thoracic operations,12 cases received lumber operations,and 21 cases received two parts operations.Surgical outcomes were evaluated by Japanese Orthopaedic Association（JOA）score.Results JOA score of all cases improved in varying degrees.The improvement rate of received cervical operation was 66.06%±14.33%,and that of received mere thoracic operation was 56.19%±9.85%,and that of lumbar operation was 63.49%±9.78%.Twenty-one cases received tow parts operations.Forteen cases received one-stage two parts operations with improvement rate of 76.78%±3.94% and 7 cases received twostage two part operations with improvement rate of 71.79%±8.74%.Conclusion The coexistence of cervical,thoracic and lumber degenerative disease is a kind of complex disease,which involves multi-segments and presents various clinical manifestations.The condition was caused by disk herniation,spinal stenosis and ossification of posterior longitudinal ligament and hypertrophy or ossification of ligamentum flavum.The optimal surgical procedures should be selected by integrated judgment of symptoms and imaging manifestations.