摘要
目的总结退变性胸椎管狭窄症的临床特点、诊断方法和手术治疗效果。方法回顾总结获随访22例经过手术治疗的退变性胸椎管狭窄症患者的临床资料。首发症状:发病节段以下麻木15例,下肢无力4例,胸背痛3例。所有患者均行X片检查,14例行脊髓造影,16例CT扫描,其中14例为CTM检查,12例MRI检查。病变节段:单节段12例,连续两个或两个以上节段7例,跳跃式节段3例。单节段者病变位置:T1-41例;T5-83例;T9-L18例。手术方式:后路椎管后壁切除术13例,侧前方入路行减压术2例,前后路联合减压手术3例,后路环椎管减压术4例。随访时间最长64个月,最短8个月,平均36个月。结果18位患者症状有不同程度改善,有效率为81.8%。根据JOA评分标准,术后2周改善率为81.3%,最后一次随访时改善率为87.5%。结论退变性胸椎管狭窄症多发生在胸椎下段,多节段受累常见;CT和MRI是胸椎管狭窄症的主要影像诊断手段;手术治疗是唯一选择,根据胸椎管狭窄症的临床特征选择适当的手术方式,可获得满意效果。
Objective To summarize characteristics of diagnosis and surgical treatment of degenerative thoracic spinal stenosis （TSS）. Methods The clinical features were analyzed retrospectively in 22 cases with degenerative TSS which underwent surgical treatment. Initaial symptom was numbness below the involved segment in 15,weakness of lower hmbs in 4 and thoracic back pain in 3 cases. X-ray films were taken in all cases,myelography in 14,CT scan in 16,CT Myelography in 14 and MRI in 12 cases. Types of TSS were monosegment in 12, multisegment in 7 and muhisegment with interval in 3 cases. In monnsegment cases,the location site in T1-4 was 1,in T5-8 were 3 and in T9-12 were 8 cases. 13 cases unde,＇went posterior decompression of the thoracic spinal canal,2 cases underwent anterior decompression of the thoracic canal,3cases underwent combined anterior and posterior decompression,4 cases underwent posterior circle spinal canal decompression. 22 cases were followed up from 8 to 64 months with an average of 36 months. Results 18 （81.8%）cases improved significantly. According to JOA scale,improve rate was 81.3% at two weeks alter operation and 87.5% at the recent follow-up. Conclusion Degenerative TSS exists mainly in low thoracic spine. Multisegmental TSS could exist more often. CT and MRI are the very important means for the diagnosis of TSS. Surgical treatment is the only effective treatment for TSS. The choice of surgical approach depends on the site of the compressive lesion,its level and the patients＇ pathological features.
出处
《颈腰痛杂志》
2008年第6期499-502,共4页
The Journal of Cervicodynia and Lumbodynia
关键词
胸椎管狭窄症
诊断
手术治疗
黄韧带骨化
后纵韧带骨化
thoracic spinal stenosis
diagnosis
surgical treatment
ossification of the ligamentum flavum（OLF）
ossification of the posterior longitudinal ligament（OPLL）
