胸椎间盘突出症减压术后疗效及影响因素分析

Surgical outcome and prognostic factors of decompression for thoracic disc herniation

[目的]探讨胸椎间盘突出症减压术后的手术疗效,并分析其影响因素。[方法]回顾性分析2006年1月-2013年12月因确诊胸椎间盘突出症于本院接受手术治疗并获得随访的48例患者。男26例,女22例;年龄26-73岁,平均53.6岁。术前JOA脊髓损害评分（11分法）平均（6.26±1.92）分。按JOA评分改善率进行疗效分级,并计算疗效优良率及有效率。在术前MRI矢状位T2相观察脊髓受压节段数、脊髓内有无高信号,MRI轴位T2相上观察椎间盘突出类型（中央型,侧方型）,在受压最重节段测量并计算正中矢状径残余率、硬膜囊横截面积残余率。采用多元线性回归检验年龄、性别、术前病程、术前JOA评分、中央/侧方突出、软性/硬性突出、手术节段、T2髓内高信号、手术方式、是否合并其他脊柱疾患、正中矢状径残余率、硬膜囊横截面积残余率对JOA改善率的影响。[结果]随访时间13-109个月,平均48个月。至随访结束时,疗效优良率为81.25%（39/48）,改善率平均为62.56%（-20%-100%）。多元线性回归分析显示：术前JOA评分与MRI轴位中矢状径残余率对手术疗效的影响有统计学意义（P〈0.05）,而年龄、性别、术前病程、中央/侧方突出、软性/硬性突出、手术节段、T2髓内高信号、脑脊液漏、手术入路、合并其他脊柱疾患、MRI轴位硬膜囊横截面积残余率对手术疗效的影响无统计学意义（P〉0.05）。[结论]胸椎间盘突出症减压术后疗效相对满意,MRI轴位正中矢状径残余率与术前JOA评分是胸椎间盘突出症减压术后疗效的影响因素。

To assess the effectiveness of surgical decompression,and analyze the prognostic factors relevant to patients with thoracic myelopathy caused by thoracic disc herniation（ TDH）. [Methods] Forty- eight patients,who underwent surgical decompression due to thoracic myelopathy induced by TDH between Jan 2006 and Dec 2013 and were completely followed up,were retrospectively reviewed. Among these 48 cases,there were 26 male and 22 female with a mean age of 53. 6years（ range,26 - 73 years）. Modified JOA scale and its improvement ratio were used to evaluate the outcomes. The mean JOA score was（ 6. 26 ± 1. 92） points preoperatively. The number of compressed levels,intramedullary high intensity signal on the sagittal plane,and TDH type（ central type or lateral type） on the axial plane of T2 weighted MRI were observed and recorded respectively. Additionally,ratio of the remaining dural- sac area and ratio of the remaining sagittal diameter of the canal were measured and calculated at the maximally compressed level. Correlations between the surgical outcome and various factors,such as age,gender,preoperative disease process, the image parameters and etc. were analyzed by multiple linear regressions.[Results] The patients were followed up for an average of 48 months（ 13- 109 months）. At the end of follow- up,the excellent or good results were gotten in 81. 25% of the patients（ 39 /48）,and the average improvement ratio was 62. 56%（- 20%to 100%）. The multiple regression revealed that only the ratio of remaining sagittal diameter on axial MRI and preoperative JOA scores were significantly correlated with improvement ratio（ P〈0. 05）. Conversely, age, gender, preoperative disease process,TDH type, soft / rigid herniation, segments involved,leakage of cerebrospinal fluid,intramedullary high intensity signal,surgical approach, other accompanied spinal degenerative diseases,and the ratio of remaining dural- sac area had no significant effect on surgical outcome（ P〈0. 05）. [Conclusion]Surgical decompression is effective for treatment of patients with thoracic myelopathy caused by TDH. The ratio of remaining sagittal canal diameter on axial MRI and preoperative JOA scores might have significant effect on surgical outcome.