胸椎管狭窄症的治疗

The treatment of thoracic spinal stenosis

目的:探讨胸椎管狭窄症的临床特点与手术方式选择。方法:回顾性分析81例各种原因致胸椎管狭窄症的临床及影像学表现、手术方式及其治疗效果。结果:69例获得平均6年8个月随访。采用整块半关节突全椎板切除术（包括8例加行侧前方减压术）共治疗41例,优33例。良5例、无改变2例,差1例;前路椎体部分切除、植骨、内固定治疗2例为优;传统椎板减压术26例,优13例、良3例、无改变5例,差5例。结论:胸椎管狭窄症可由多种脊柱疾患引起;根据不同病理改变相应采用整块半关节突全椎板切除术或加侧前方减压、前路减压术是治疗胸椎管狭窄症的有效术式。

Objective:To study the clinical features and the operation approaches for the thoracic spinal stenosis. Method: The clinical manifestations, imageology, operation approaches and therapeutic effects of the 81 various thoracic spinal stenosis were retrospectively analyzed. Result:69 cases were offered six-month to 20-years follow-up survey with the average period of 6. 8 years. Among the 41 cases treated with en bloc hemi-articular process total laminectomy including 8 cases with additional anterior-lateral decompression,the therapeutic effect of 33 were excellent,5 good,2 with no change and 1 poor; the 2 cases treated with the anterior partial pyramid excision,bone grafting and internal fixation were excellent result;and of the 26 cases treated with traditional laminectomy, 13 were excellent,3 good,5 without change and 5 poor. Conclusion; (1)The thoracic spinal stenosis can be resulted from the ossification of thoracic vertebae ligamentum flavum,the intrabony cartilage nodule in their thoracic pyramid posterior borders, fluorosis of bone,DISH,OPLL,et al;(2)The en bloc hemi-articular process total laminectomy, anterior-lateral decompression and anterior decompression are the effective approaches for treating thoracic spinal stenosis caused by related causes.