后路减压植骨融合术治疗多节段胸椎间盘突出症的疗效

Posterior Laminectomy and Lateral Bone Fusion on Multi-segments Thoracic Disk Herniation: 18 Cases Report

目的探讨后路椎板减压髓核摘除侧后方植骨融合固定术治疗多节段胸椎间盘突症的临床疗效。方法 18例多节段胸椎间盘突出症患者接受后路减压植骨融合术治疗。根据日本骨科协会（JOA）脊髓损害评分及Frankel分级系统评价手术效果。结果手术时间150-260 min,平均190.6 min;术中出血量430-1400 ml,平均806.3 ml;3例患者术中发生脑脊液漏,经加压包扎后愈合;1例术后发生伤口感染,给予敏感抗生素后伤口逐步愈合。局部Cobb角由术前的（18.7±4.1）°降低为术后3个月的（10.2±3.3）°及末次随访时的（11.3±3.6）°（P〈0.05）。术后3个月及末次随访时JOA评分均较术前均有恢复（P〈0.05）;末次随访时Frankel分级：B级3例,C级4例,D级5例,E级6例。术后随访14-35个月,随访期间无内固定物松动、移位及脊柱不稳发生。结论后路椎板减压髓核摘除侧后方植骨融合固定术是治疗多节段胸椎椎间盘突出症的有效术式,脊髓减压充分,脊柱稳定性可获得长久维持。

Objective To observe the therapeutic effects of posterior laminectomy and lateral bone fusion on multi-segments thoracicdisk herniation. Methods 18 patients with multi-segments thoracic disk hemiation accepted the posterior laminectomy and lateral bone fu-sion. They were followed up with JOA score and Frankel system. Results The mean of operative time was 190.6 min with a mean of bloodloss of 806.3 ml. Cerebrospinal fluid leakage happened in 3 patients, and recovered after treatment. Wound infection occurred in t case andrecovered after applied sensitive antibiotics. The Cobb＇s angle decreased after surgery （P〈0.05）. Compared with the preoperative, the JOAscore improved 3 months later and at the last follow-up （P〈0.05）. During the follow-up, there was no fixation loosen, displacement and spi-nal instability happened. Conclusion Patients with multi-segments thoracic disk herniation may benefit full spinal decompression and a sta-ble spinal sagittal alignment from posterior laminectomy and lateral bone fusion.