胸腰段椎管狭窄症的临床特点和治疗

[目的]探讨胸腰段椎管狭窄症的临床特点、手术治疗方法.[方法]回顾总结胸腰段椎管狭窄症资料21例,采用后路全椎板切除6例、全椎板切除+椎弓根钉系统内固定12例、前路手术+内固定3例;分析其病理类型及术后疗效.[结果]胸腰段椎管狭窄病理类型包括关节突关节内聚增生、后纵韧带骨化、黄韧带骨化、黄韧带肥厚、Scheuermann病或非典型Scheuermann病伴椎间盘突出.术后随访1～3年,平均2.1年,采用JOA评分评价疗效:优9例,良7例,一般3例,差2例,优良率76.2％.[结论]胸腰段椎管狭窄症神经压迫症状较重,应尽早明确诊断,根据不同病理类型、选择合适的手术方式有针对的进行减压是治疗的关键.

Clinical features and treatment of thoracolumbar stenosis

[Objective]To summarize the feature and operative treatment of thoracolumbar stenosis.[Methods]Different treatments of thoracolumbar stenosis in 21 cases were analyzed retrospectively,including full laminectomy in 6 cases,full laminectomy and internal fixation with pedicle screw system in 12 cases,anterolateral approach with internal fixation in 3 cases.The pathology categories and postoperative effect were evaluated.[Results]All patients were followed up for 1-3 years(average,2.1 years).The results were excellent in 9 cases,good in 7,fair in 3,and poor in 2,with good to excellent rate of 76.2%.[Conclusion]The clinical situation of thoracolumbar stenosis is complicated,usually with severe nerve compression.Clear diagnosis and early rational therapy on the basis of different pathology categories are important.