胸椎退变致胸髓压迫的诊断和治疗

目的 探讨胸椎退行性改变致慢性胸髓压迫症的早期诊断和治疗方法。方法 ２１例胸椎管狭窄症患者,男９例,女１２例,平均年龄４９．５岁;单纯苋韧带骨化症１６例,Ｓｃｈｅｕｅｍａｎｎ病３例,弥散性特发性骨质肥大症２例;采用ＣＴ、ＣＴＭ、ＭＲＩ及磁刺激ＭＥＰ等检查;用“揭盖法”椎管后侧壁切除及合并前方减压法手术治疗;按ＪＯＡ评分及Ｅｐｓｔｅｉｎ的标准评定手术疗效。结果 ２１例中,局灶型５例,连续型１０例,跳

Diagnosis and treatment of thoracic myelopathy due to degenerative thoracic spine disease

OBJECTIVE: To summarize the experience in the early diagnosis and treatment of chronic thoracic myelopathy due to the compression of degenerative thoracic spine disease. METHODS: 21 patients with thoracic spinal stenosis were operated on from January 1995 to April 2000. Etiologically 16 patients were found to have ossification of the ligamentum flovum, 3 Scheuermann's disease, and 2 DISH. They were confirmed by CT, CTM, MRI and Magnetic MEP. Decompression was performed by en block unroof laminectomy for the posterolateral wall of the thoracic canal. The epstein criteria were used to judge the operative results. RESULTS: In the 21 patients 5 belonged to localized type, 10 continuous type, and 3 skip type in 21 cases. Three patients showed a compression from the anterior side, and 3 were complicated by OPLL of the cervical spine. Results were excellent in 4 patients, good in 8, improved in 2, and poor in 1. One patient was operated on two times because the extent of laminectomy was not enough for the first operation. CONCLUSIONS: Early diagnosis can be made if orthopedists are familiar with the clinical characteristics of thoracic myelopathy, and are alert to thoracic spine stenosis. En block unroof laminectomy is effective and safe to treat thoracic spine stenosis.