经侧前方肋间隙胸膜外入路切除胸椎椎体后缘骨内软骨结节的胸椎管减压

Removal of intraosseous cartilaginous node originated from thoracic vertebrae via anterolateral extrapleural approach

中文关键词:  胸椎管狭窄症  椎体后缘骨内软骨结节  胸膜外入路  疗效

英文关键词:Thoracic spinal stenosis  Intraosseous cartilaginous node  Extrapleural approach  Outcome

中文摘要:

  【摘要】 目的：探讨侧前方经肋间隙胸膜外入路手术切除胸椎椎体后缘骨内软骨结节治疗胸椎管狭窄症的方法和疗效。方法：2002年4月~2012年9月，对18例明确诊断为胸椎椎体后缘骨内软骨结节所致椎管狭窄症患者采用经侧前方肋间隙胸膜外入路减压内固定融合术治疗，男12例，女6例；年龄33~61岁，平均46岁。影像学证实均为单一节段椎体后缘骨内软骨结节，且不合并胸椎黄韧带骨化及后纵韧带骨化。病变节段：T7/8 2例，T8/9 4例，T9/10 5例，T10/11 7例。术前神经功能Frankel分级：C级6例，D级12例；JOA评分6.6±1.3分。观察术后疗效和并发症发生情况。结果：18例患者均顺利完成手术，平均用时3.5h，平均出血量420ml（350~620ml），术后无气胸、胸腔积液等并发症发生；1例术后1周发生肺炎，5例术后第2天复查胸片时发现邻近肋骨骨折，均经保守治疗后痊愈。所有患者均获得随访，随访时间2~12年，平均6年。疗效参照Epstein标准评价，优15例，良2例，差1例，优良率94%（17/18）。术前Frankel分级为C级的患者1例无明显改善，1例改善至D级，4例改善为E级；12例D级患者均改善为E级。JOA评分改善到9.4±1.6分，与术前比较有显著性差异（P<0.05）。术后1年复查CT见椎间植骨区表面有连续性骨小梁通过，末次随访时影像学检查未发现内固定断裂、松动和植骨不融合现象。结论：对于胸椎椎体后缘骨内软骨结节所致胸椎管狭窄症患者，采用经侧前方肋间隙胸膜外入路胸椎椎体后缘骨内软骨结节切除减压可取得较好的临床疗效，是一种安全有效的手术方式。

英文摘要:

  【Abstract】 Objectives： To investigate the surgical method and its outcome of the removal of intraosseous cartilaginous node originated from thoracic vertebrae via anterolateral extrapleural approach. Methods: From April 2002 to September 2012, 18 cases diagnosed as single segmental thoracic vertebral intraosseous cartilaginous node were reviewed retrospectively, those cases with thoracic ossification of ligamentum flavum(OLF) and ossification of posterior longitudinal ligaments(OPLL) were excluded from this series. There were 12 males and 6 females, with an average age of 46 years(33-61 years). 2 cases had lesions located in T7/8, 4 cases in T8/9, 5 cases in T9/10, and 7 cases in T10/11. According to Frankel classification, there were 6 cases at grade C and 12 at grade D preoperatively. The outcome and complication rate were observed. Results: Surgery was performed successfully on all 18 cases. The mean operation time was 3.5 hours, and the mean blood loss was 420ml(350-620ml), pneumothorax or pleural effusion was not noted after operation. Complications were noted in 6 cases, 1 case was complicated with pneumonia one week after operation and 5 cases were founded with rib fractures the next day after operation when taking chest X-ray. All recovered after conservative treatment. All patients were followed up for an average time of 6(2-6 years) years. Based on the Epstein criteria, excellent was noted in 15 cases, good in 2 cases and poor in 1 case, with an excellent and good rate of 94%(17/18). One case had neurofunction remain unchang, while 1 case improved from C to D, and all reached E. At final follow-up, postoperative JOA score increased from 6.6±1.3 to postoperative 9.4±1.6, no instrument failure was noted, and bony union was evidenced on CT scan 1 year later. Conclusions: For patients with thoracic spinal stenosis induced by intraosseous cartilaginous node, decompression via anterolateral extrapleural approach is a safe and effective option.