保留棘突椎板的经关节突入路治疗胸椎椎间盘突出症

摘要

Objective To evaluate the clinical outcome of thoracic discectomy via spinous process and lamina preserved trans-facet-joint approach in the treatment of thoracic disc hemiation. Methods Eight cases were included in this group from October 2009 to August 2011, including 6 males and 2 females. The age ranged from 24 to 49 years old, with an average age of 35. 4 years. The course of disease ranged from 1 to 9 months. Five cases had the injury history and the rest had no obvious predisposition. Five cases were simple thoracic disc hemiation. One case was associated with ossified posterior longitudinal ligament( OPLL ). Two cases were associated with osteophyte formation of posterior edge. The involved discs were T8/ T9 in 1 case, T9/ T10 in 2 cases, T10/ T,, in 2 cases, T11/ T12 in 1 case, and T12/L, in 2 cases. All the hemiated discs, OPLL and osteophyte were excised via spinous process and lamina preserved trans-facet joint approach bilaterally. The adjacent 2 segments were instrumented in all cases. Results Follow-up was acquired in all 8 cases,ranged from 3 to 15 months ( mean 9 months ). According to Epstein grading, the outcomes were excellent in 6 cases,good in 1 case and bad in 1 case. The excellent and good rate was 87.5%. Conclusion Thoracic discectomy via spinous process and lamina preserved trans-facet joint approach can acquire satisfactory clinical outcome.%目的 探讨保留棘突椎板的经关节突入路治疗胸椎椎间盘突出症的手术方法及疗效.方法 2009年10月～2011年8月,采用保留棘突椎板的经关节突入路治疗8例单节段胸椎椎间盘突出症患者,其中男6例,女2例;年龄24～49岁,平均35.4岁;病程1～9个月,5例有外伤史,其余发病无明显诱因.单纯椎间盘突出5例,合并后纵韧带骨化1例,合并椎体后缘骨赘形成2例.病变节段为T8/T9 1例,T9/T10 2例,T10/T11 2例,T11/T12 1例,T12/L1 2例.手术保留棘突椎板,采用经双侧关节突入路切除突出椎间盘、骨化的后纵韧带及后缘骨赘.8例均采用双侧相邻节段钉棒固定.结果 8例患者均获得随访,随访时间3～15个月,平均9个月.疗效评价参照Epstein标准,优6例,良1例,差1例,优良率87.5%(7/8).结论 保留棘突椎板的经关节突入路切除突出的胸椎椎间盘可获得满意疗效.