胸椎椎间盘突出症后外侧入路几种手术方式的选择

目的探讨胸椎椎间盘突出症的临床表现、诊断及后外侧入路椎间盘摘除术治疗胸椎椎间盘突出症的手术效果。方法回顾1995年1月~2006年5月经后外侧入路椎间盘摘除术治疗的27例胸椎椎间盘突出症患者,分析其临床特点、影像学改变及手术治疗方法。本组患者共27例,男16例,女11例,平均年龄44.2岁。均采用经后外侧入路椎间盘摘除术,其中经肋骨横突入路摘除椎间盘2例,经椎间孔外侧前方入路摘除椎间盘11例,经关节突入路摘除椎间盘14例。结果随访1~l0年,25例患者脊髓神经功能均有不同程度改善,1例T10,11巨大椎间盘突出的患者无改善,1例T8,9椎间盘突出合并后纵韧带骨化的患者术后症状加重,总体手术优良率达92.6%。结论CT或MRI检查对确诊与定位有重要价值。可根据椎间盘突出的大小、位置等情况选择其入路。经后外侧入路椎间盘摘除术是治疗胸椎椎间盘突出症比较有效、安全的术式。

Strategy of posterolaeral disc extraction for the treatment of thoracic disc herniation

Objective To investigate the clinical manifestation, diagnosis of thoracic disc herniation, and surgical result of disc extraction at a posterolateral approach. Methods From Jan.1995 to May 2006, 27 cases with thoracic herniation who underwent trans-posterolaeral disc extraction through posterolateral approach were retrospective analyzed on the clinical appearances, imageology and operative methods. Of the 27 cases with a average age of 44.2, 16 cases were males and 11 were females. Posterolaeral disc extraction were performed on all patients, including costotransverse approach in 2 cases, foramen anterolateral approach in 11 cases and articular approach in 14 cases. Results After 1-10 years follow-up, 25 cases improved their neurofunction by different digrees, while one case with huge disc herniation at T_ 10,11 got no improvement and one case with T_ 8,9 disc herniation combined with ossification of posterior longitudinal ligament got exacerbation. Excelent and good results were obtained in 92.6% of the patients. Conclusion CT or MRI is valuable for the diagnosis of thoracic disc protrusion.Operative treatment is an efective safe way with posterolateral or anterolateral approach and both laminectomy and transversoarthropediculectomy for thoracic disc protrusion. Conclusion CT or MRI is valuable for the diagnosis of thoracic disc protrusion. Operative approach should be selected according to the size and location of herniated disc. Trans-extrapleural disc extraction is an efective safe way for the treatment of thoracic disc herniation.