胸椎管狭窄的手术疗效及预后分析

目的　探讨胸椎管狭窄的特点、手术疗效及影响胸椎管狭窄预后的因素。　方法　对 1992年 9月～2 0 0 1年 1月因退行性变、黄韧带骨化、非特异性弥漫性骨肥厚及创伤后等导致胸椎管狭窄 16例患者的临床资料进行回顾性调查。经 6个月～ 9年随访 ,平均 4 5 .6个月。对比手术前后疼痛、日常活动及截瘫指数 ,并用 Wilcoxon秩和检验和偏相关分析年龄、狭窄受累节段数及病程对胸椎管狭窄预后的影响。　结果　统计学分析显示 ,手术后患者疼痛分度、活动分极和截瘫指数较手术前明显改善 (P<0 .0 1) ;在年龄、狭窄受累节段数及病程等 3个因素中 ,只有病程长短与术后截瘫指数评分明显相关 (P<0 .0 5 )。　结论　胸椎管狭窄早期手术直接解除脊髓压迫可获良好疗效 ;病程影响胸椎管狭窄的预后 ,而年龄和受累节段数对预后的影响无明显关联。

OPERATIVE RESULTS AND PROGNOSIS OF THORACIC SPINAL STENOSIS

Objective To discuss the clinical properties, operative results of thoracic spinal stenosis and factors correlating with prognosis. Methods From September 1992 to January 2001, 16 patients who suffered from thoracic spinal stenosis caused by degeneration, ossified ligamentum flavum, diffuse idiopathic hyperostosis and trauma, were decompressed by operation. The operative method was selected according to the compressed position of spinal cord. All patients were followed up 6 months to 9 years. The pain severity, ambulatory status and paraplegia index were compared between before operation and after operation. The correlation between prognosis and ages, the length of stenosis and the duration of disease was studied. Results The results of Wilcoxon Signed Ranks Test show significant difference in pain severity, ambulatory status and paraplegia index between before operation and after operation ( P <0 0l). The results of partial correlation analyzing show that only the duration of disease was correlated with paraplegia index (P <0.05). Conclusion Thoracic spinal stenosis frequently develops in the lower thoracic segments in middle and old aged men. Decompression by operation early can achieve a good clinical result. Duration of disease affects the prognosis.