“菱形”截骨切除脊髓前方致压物治疗硬化性胸及胸腰段椎间盘突出症

"Diamond" osteotomy for removing anterior compressions of spinal cord in sclerosing thoracic and thoracolumbar disc herniation

中文关键词:  胸椎间盘突出症  胸腰段椎间盘突出症  手术入路  手术治疗  椎间盘切除

英文关键词:Thoracic disc herniation  Thoracolumbar disc herniation  Diamond surgical approach  Surgical treatment  Discectomy

中文摘要:

  【摘要】 目的：探讨经后路“菱形”截骨切除脊髓前方致压物治疗硬化性胸及胸腰段椎间盘突出症的临床疗效。方法：2009年8月～2014年7月，共收治26例硬化性胸及胸腰段椎间盘突出症患者，男19例，女7例；年龄平均43．8±23.3岁（18～70岁）。19例为胸椎间盘突出，包括胸椎间盘突出并钙化14例，胸椎后缘骨赘5例；7例为胸腰段椎间盘突出并钙化。术前神经功能Frankel分级：B级3例，C级14例，D级9例。手术均采用经后路“菱形”截骨切除脊髓前方致压物。手术疗效评价参照改良Macnab疗效评定标准及Frankel分级，随访观察治疗效果。结果：手术均顺利完成，术后X线片显示内固定位置良好，CT显示突出物切除彻底。1例患者（T10/11）术后出现症状加重（Frankel分级由D级变为C级），经甲强龙、脱水剂、营养神经药物治疗后恢复至术前水平。随访5～36个月，平均19.8个月。24例患者术后神经功能获不同程度恢复（2例Frankel D级患者无变化）。根据改良Macnab疗效评定标准，本组优15例，良8例，可2例，差1例，优良率88．46％（23/26），总有效率96．15％（25/26）。所有患者均获得骨性融合，无内固定松动断裂等并发症发生。结论：经后路“菱形”截骨切除脊髓前方致压物治疗硬化性胸及胸腰段椎间盘突出症可获得满意疗效。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical outcome of "diamond" osteotomy in sclerosing thoracic and thoracolumbar disc herniation． Methods: Twenty-six cases of patients from August 2009 to July 2014 were included in this study, 19 patients were males and 7 patients were females. The age ranged from 18 to 70 years, with an average of 43．8±23.3 years. 19 patients had thoracic disc herniation, including 14 cases of thoracic disc protrusion with ossification and 5 cases of thoracic vertebra posterior osteophytes. 7 patients had thoracolumbar disc herniation with ossification. The preoperative Frankel grade evaluation showed that there were 3 cases of grade B, 14 cases of grade C and 9 cases of grade D. All the cases were treated by the "diamond" osteotomy to remove anterior compressions of spinal cord. The modified Macnab criteria and Frankel grade were used to evaluate the clinical outcomes. Results: The "diamond" osteotomy was successfully completed in all the patients. Only 1 case(T10/11) was observed exacerbation in preexisting deficits after operation. The patient recovered to preoperative level after treated with methylprednisolone, dehydrate and neural nutrition. X-ray showed no malposition of internal fixation, and the computerized tomography(CT) scan showed complete removal of compressor. All the 26 patients were subjected to an average of 19.8 months(range 5 to 36 months) follow-up. Neurological function improved in all the patients. According to the modified Macnab criteria, there were 15 cases of excellent grade, 8 cases of good grade, 2 cases of improvement, and only 1 case of poor grade. The rate of excellent and good grades was 88.46% and the total effective rate was 96.15%. All patients acquired bony fusion without instrument failure． Conclusions: The "diamond" osteotomy was effective to improve the clinical outcome obviously in patients with thoracic and thoracolumbar disc herniation．