胸椎管狭窄症24例报告

Thoracic Spinal Canal Stenosis with 24 Cases Report

目的 :探讨胸椎管狭窄症的诊治特点 ,加深对胸椎管狭窄症的认识。方法 :总结 2 4例胸椎管狭窄症患者 ,2 2 ( 92 % )例存在狭窄段以下感觉障碍平面及下肢无力 ,束带感 4例 ,行走困难 11例 ,大小便功能障碍 7例 ,17例背部叩痛 ,叩痛部位与病变部位均存在对应关系。所有病人均行X线片及MRI扫描 ,18例CT扫描 ,1例椎管造影。狭窄分布 :5例累及上胸段 ,4例累及中胸段 ,2 2例累及下胸段。 4例单椎间关节型 ,5例跳跃性多椎关节型 ,15例多椎间关节型 ,10例伴有椎间盘突出。手术方法均采用后入路 ,18例采用整块切除方法。结果 :功能评定采用Mann标准。术后缓解率为 91.7% ,获随访的 17例中 ,最长 4年 ,最短 3个月 ,平均 2 5 .7个月 ,恢复优良率为 70 .6 %。结论 :退变性胸椎管狭窄症多发生在胸椎下段 ,多表现为多节段受累 ,常见跳跃性狭窄 ;主要病理改变为黄韧带的肥厚、骨化 ,关节突肥大及椎板增厚 ,常伴有椎间盘突出 ;CT及MRI是TSS的主要影像诊断手段 ;手术治疗主张后入路 。

Objective:New characteristics in diagnosis and treatment of thoracic spinal canal stenosis (TSS) was studied.Methods:To summarize the clinical and radiographic apperances,the plane of paraparesis and weakness of lower limbs were existed in 22 cases.Strangulated sensation in 4 cases,ambulation dysfunction in 11 cases and urinary incontinence in 7 severe cases.Percussion tenderness in 17 cases.The percussion tenderness and the site of impingement was correlated.Types of TSS are monosagment in 4,multisegment in 15 and multisegment with interval in 5 cases.TSS with thoracic disc herniation in 10 cases.Dorsal approach was used in all patients.They were treated by en bloc hemi apophysio laminectomy and discectomy in 18 and general laminectomy in 6.Results:Function results were evaluated using Mann classification.Relief rate was 92% after operation.Average follow up time 25.7 months to 17 of 24 cases,excellent and good recovery rate was 70.6%.Conclusion:Etiology of TSS was degenerative mainly.Accompanied with thoracic disc herniation in common.Continuous and jumping stenosis could exist more often.Diagnosis was best made from the computerized tomography and magnetic resonance imaging.Dorsal approach was advocated in decompression.En bloc hemi apophysio laminectomy was recommened to cases with severe ossification.