骨化胸椎间盘突出症后路360°椎管减压的疗效分析

Clinical outcome of posterior approach 360° vertebral canal decompression for ossifying thoracic disc herniation

目的 探讨后路360°椎管减压、椎间植骨融合、椎弓根螺钉内固定术治疗骨化胸椎间盘突出症的手术疗效.方法 2006年1月至2012年1月39例骨化胸椎间盘突出症患者行胸后路360°椎管减压,椎间植骨融合、椎弓根螺钉内固定术手术治疗,其中男性21例,女性18例;年龄33～69岁,平均53岁.病程1 ～18个月,平均6.5个月.突出部位：T7～81例,T8～9 4例,T9 ～ 10 9例,T10 ～ 117例,T11～1210例,T12～L16例,T11～12、T12～L1两节段突出2例.采用Otani等评分系统进行术后疗效评估并计算临床优良率,评价治疗效果.结果 手术时间2.5～5.0h,平均3.3h;出血量400～2000 ml,平均850 ml.所有患者手术均顺利完成,均无神经症状加重及意外发生.术后随访24～60个月,平均40.5个月,根据Otani等评分标准,优16例,良18例,可5例,差0例;优良率为87.2％.所有患者均获得骨性融合,均无内固定物松动、断裂等并发症发生.结论 后路360°椎管减压、椎间植骨融合、椎弓根螺钉内固定术治疗骨化胸椎间盘突出症可取得良好的临床疗效,并发症发生率低.

Objective To evaluate the clinical results and the value of the posterior approach 360° vertebral canal decompression and transfacet discectomy combined with interbody fusion and pedicle screw internal fixation for the treatment of ossifying thoracic disc herniation.Methods Thirty nine cases of ossifying thoracic disc herniation who accepted the posterior approach 360° vertebral canal decompression and transfacet discectomy combined with interbody fusion and pedicle screw internal fixation were included in this study.There were 21 male and 18 female patients.The age ranged from 33 to 69 years,with an average of 53 years.The course of disease ranged from 1 month to 18 months,with an average of 6.5 months.The lesion locations were T7-8 for 1 case,T8-9 for 4 cases,T9-10 for 9 cases,T10-11 for 7 cases,T11-12 for 10 cases,T12-L1 for 6 cases,and both T11-12 and T12-L1 for 2 cases.The clinical results were evaluated by Otani scored system.Results The operative time was from 2.5 to 5.0 hours,with average of 3.3 hours.The blood loss was from 400 to 2 000 ml,with average of 850 ml.All patients were successfully operated without neurological symptoms aggravation and accidents.The followed-up period was 24 to 60 months,mean 40.5 months.According to Otani scored system,there were excellent results in 16 cases and good results in 18 cases.The clinical satisfaction rate was 87.2％.All obtained bony fusion without instrument failure.Conclusion Posterior approach 360° vertebral canal decompression and transfacet discectomy combined with interbody fusion and pedicle screw internal fixation is a safe and effective surgical procedure for the treatment of ossifying thoracic disc herniation.