经椎弓根椎管后侧方整块切除术治疗胸椎管狭窄症

目的 探讨经椎弓根椎管后侧方整块切除胸椎管后壁、双外侧壁治疗胸椎管狭窄症的安全性和疗效.方法 2004年6月至2008年12月,采用经椎弓根椎管后侧方整块切除术治疗胸椎管狭窄症患者23例,男12例,女11例;年龄38～62岁,平均46岁;病程1.5～20个月,平均6.5个月.其中单纯黄韧带骨化18例,合并胸椎后纵韧带骨化4例,椎板软骨瘤1例;术前CT、MRI均显示脊髓受压.术前ASIA分级:A级1例,B级3例,C级7例,D级12例.采用ASIA分级评定术后神经功能程度.结果 手术时间90～210 min,平均(163±31)min;术中出血量600～3200 ml,平均(2150±650)ml;10例T9～T12椎管狭窄者使用经椎弓根系统固定.5例切除部分硬膜者取自体腰背筋膜修补.术后2例发生脑脊液漏,经改变体位、加压包扎引流管等处理后愈合.术后6例发生迟发脊髓功能障碍(术后3 h～4 d肌力下降至0级或较术前下降2～3级)致截瘫加重,经脱水、甲基泼尼松龙冲击、高压氧、营养神经药物等治疗,6个月复查时恢复到术前水平.23例患者均获得随访,随访时间16～58个月,平均30个月.术后ASIA分级:A级1例,B级2例,C级2例,D级5例,E级13例.结论 避开硬化的皮质骨和骨化的黄韧带,经松质骨两侧由椎间孔开槽和切断椎弓根侧方,不进入椎管整块切除后壁、双外侧壁治疗胸椎管狭窄的方法安全.

Transpedicular osteotomy en bloc lamina resection for the treatment of thoracic spinal stenosis

Objective To study the safety and efficacy of transpedicular osteotomy en bloc lamina resection to treat thoracic spinal stenosis.Methods A retrospective study of 23 consecutive patients underwent transpedicular osteotomy en bloc lamina resection from June 2004 to December 2008,including 12 males and 11 females,with a mean age of 46 years(range,38-62 years)was conducted.The courses of diseases were 1.5 to 20 months with an average of 6.5 months.There were 18 cases caused by thoracic ossification of ligamentum flavum(OLF),4 cases caused by ossification of posterior longitudinal ligament(OPLL)and 1 case caused chondroma.Preoperative CT and MRI examinations showed that all patients got spinal cord compression.Preoperative ASIA Grade was A for 1 case,B for 3 cases,C for 7 cases and D for 13 cases.Postoperative neurological status was evaluated by ASIA grade system.Results The postoperative follow-up duration ranged from 16 to 58 months(mean 30 months).The operation time varied from 90 to 210 min,with the average of 163 min.Blood loss varied from 600 to 3200 ml,with the average of 2150 ml.Pedicle screws were used in 10 cases with T9-T12 stenosis,and dura excisions were repaired by lumbodorsal fascia in 5 cases.Cerebrospinal fluid leakage occurred in 2 cases.Postoperative ASIA grade showed that there was A for 1 case,B for 2 cases,C for 2 cases,D for 5 cases and E for 13 cases.Conclusion Transpedicular osteotomy is a good approach,which avoid sclerotic cortex and ossified ligamentum flavum,to resect en bloc lamina with with shorter operative time and less blood loss.