后路环形减压治疗胸椎椎间盘突出伴骨化的疗效

目的：探讨经后路环形减压植骨融合内固定术治疗胸椎椎间盘突出伴骨化的可行性、安全性、有效性。方法25例胸椎椎间盘突出伴骨化患者在我院接受经后路环形减压植骨融合内固定术。病变节段：T4/5、T5/62例，T6/71例，T8/92例，T9/104例，T10/116例，T11/128例，根据日本骨科协会（ Japanese Orthopaedic Association ， JOA）评分及Otani评分系统对手术疗效进行评估。结果手术时间（175．7±12．4） min，术中出血量（630．8±33．7）ml，5例术中发生脑脊液漏，经治疗后愈合；1例术后双下肢肌力逐渐降低，考虑伤口内血肿形成，给予清创后肌力恢复至术前水平。 JOA评分由术前的6．3±2．1，恢复为术后3个月的9．4±3．0，以及末次随访时的9．7±3．3，手术前后比较，差异有统计学意义（P＜0．05）；末次随访时根据Otanni评分获优13例，良8例，可3例，差1例，优良率为84．0％。术后随访15～34个月，随访期间未出现神经症状加重及脊柱不稳等情况发生。结论经后路环形减压植骨融合内固定术治疗胸椎椎间盘突出伴骨化可获得较好的临床效果，术中需注意脑脊液漏的发生。

Clinical efficacy of posterior circular decompression to treat thoracic disk herniation combined with ossification

Objective To investigate the clinical outcomes of posterior circular decompression to treat thoracic disk herniation combined with ossification .Methods Twenty-five patients who had thoracic disk herniation combined with ossification underwent the procedure of posterior circular decompression .The lesion segment was T 4/5、T5/6 in 2 cases, T6/7 in 1case, T8/9 in 2 cases, T9/10 in 4 cases, T10/11 in 6 cases and T11/12 in 8 cases.The postoperative curative effect was measured by JOA score and Otani scoring system . Results The average operative time was （175.7 ±12.4） min with a mean blood loss was （630.8 ±33.7） ml.Five patients exhibited intraoperative cerebrospinal fluid leakage , and recovered after treatment .One case developed wound hematoma and recovered after an emergency debridement.Compared with the preoperative level （6.3 ±2.1）, the JOA score had a significant recovery at 3 months （9.4 ±3.0） and at the last follow-up （9.7 ±3.3）（P〈0.05）.The Otani score at the last follow-up was excellent in 13 patients, good in 8 patients, fair in 3 patients, and poor in 1 patient, and the good response rate was 84.0%.Conclusions The posterior circular de-compression in treating thoracic disk herniation combined with ossification can obtain good clinical results .However , attention should be paid to avoid cerebrospinal fluid leakage .