后外侧入路减压椎间植骨融合内固定治疗胸椎管狭窄症的疗效及安全性

Curative effect and safety of posterolateral approach decompression and discectomy combined with interbody fusion and pedicle screw internal fixation for thoracic spinal stenosis

目的：探讨后外侧入路减压、椎间植骨融合、椎弓根螺钉内固定手术治疗胸椎管狭窄症的疗效及安全性。方法：2006年1月～2012年3月，收治单节段腹侧压迫致胸椎管狭窄症患者22例，男14例，女8例，年龄33～69岁，平均53.5岁。病程1～18个月，平均6.7个月。椎间盘突出部位：T7/81例，T8/94例，T9/109例， T10/118例。术前脊髓功能Frankel分级：B级5例，C级11例，D级6例。所有患者均行后外侧入路减压、椎间植骨融合、椎弓根螺钉内固定手术。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2.5～5h，平均3.2h，出血量400～1800ml，平均800ml。2例患者术后即刻有短暂脊髓功能障碍加重，经及时给予甲基强的松龙冲击、消肿、营养神经等治疗，分别于术后8h及24h开始逐渐恢复，其余20例患者术后即刻脊髓功能较术前恢复。术后随访24～60个月，平均40个月。末次随访时所有患者神经功能均明显改善，Frankel分级：C级3例，D级6例，E级13例。根据Otani等分级标准，优13例，良6例，可3例；优良率为86.36%。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：后外侧入路减压、椎间植骨融合、椎弓根螺钉内固定手术治疗胸椎管狭窄症可取得良好的临床疗效，操作安全，并发症少。

Objectives： To study the efficacy and safety of the posterolateral approach decompression and discectomy combined with interbody fusion and pedicle screw internal fixation for the treatment of the thoracic spinal stenosis. Methods： Twenty two cases with the thoracic spinal stenosis undergoing the posterolateral decompression and discectomy combined with interbody fusion were included in this group. There were 14 males and 8 females. The age ranged from 33 to 69 years old, with an average of 53.5 years. The course of disease ranged from 1 month to 18 months, with an average of 6.7 months. The lesion was T7/8 in 1 case, T8/9 in 4 cases, T9/10 in 9 cases, T10/11 in 8 cases. Frankel grade B was noted in 5 cases, C in 11 cases and D in 6 cases. The clinical results were evaluated by Frankel grade and Otani score system. Results： The operation time was 2.5-5 hours, with an average of 3.2 hours. The blood loss was 400-1800 ml, with an average of 800ml. 20 cases had immediate postoperative neurological improvement. 2 cases, who experienced transient postoperative neurological deterioration, were treated with methylprednisolone, detumescence and nerve nutrition therapy in time, then recovered by degrees at 8 and 24 hours postoperative respectively. The followed-up period was 24 to 60 months（mean, 40 months）. At final follow-up, all patients had some ex-tent of neurological improvement, with Frankel grade C in 3 cases, D in 6 cases, E in 13 cases. According to Otani score system, there were excellent in 13 cases and good in 6 cases. The clinical satisfaction rate was 86.36%. All cases reached bony fusion without instrument failure. Conclusions： Posterolateral decompression and discectomy combined with interbody fusion is a safe and effective procedure for the thoracic spinal stenosis.