CAJ | 학술논문

目的探讨后路椎板切除减压、经关节突关节椎间盘切除、椎间植骨融合并节段性内固定治疗下胸椎椎间盘突出症的疗效.方法 2000年6月至2010年6月,采用后路椎板切除减压、经关节突关节椎间盘切除、椎间植骨融合并节段性内固定治疗下胸椎椎间盘突出症患者36例,男23例,女13例;年龄22～61岁,平均42岁;病程21天至69个月,平均22个月.病变位于T10-11间隙12例,T11-12间隙15例,T12L1间隙9例.所有患者均行X线及MR检查,31例患者行CT检查,其中中央型突出25例,旁中央型7例,外侧型4例.采用Otani等评分系统进行术后疗效评估并计算临床优良率,评价治疗效果.结果手术时间135～220 min,平均155 min;术中出血量350～800 ml,平均460 ml.所有患者均顺利完成手术,无神经症状加重及意外发生.12例发生脑脊液漏,予硬脊膜连续缝合或补片修补.2例巨大型椎间盘突出患者术后双下肢肌力减退,予激素、脱水、高压氧及营养神经药物治疗后肌力逐渐恢复.术后2周行X线检查示无内固定松动.随访时间14天至48个月,平均4个月.根据Otani等评分标准,优12例,良18例,可5例,差1例;临床优良率83.3%.结论后路椎板切除减压、经关节突关节椎间盘切除、椎间植骨融合并节段性内固定是治疗下胸椎椎间盘突出症安全有效的术式.
목적 탐토후로추판절제감압、경관절돌관절추간반절제、추간식골융합병절단성내고정치료하흉추추간반돌출증적료효.방법 2000년6월지2010년6월,채용후로추판절제감압、경관절돌관절추간반절제、추간식골융합병절단성내고정치료하흉추추간반돌출증환자36례,남23례,녀13례;년령22～61세,평균42세;병정21천지69개월,평균22개월.병변위우T10-11간극12례,T11-12간극15례,T12L1간극9례.소유환자균행X선급MR검사,31례환자행CT검사,기중중앙형돌출25례,방중앙형7례,외측형4례.채용Otani등평분계통진행술후료효평고병계산림상우량솔,평개치료효과.결과 수술시간135～220 min,평균155 min;술중출혈량350～800 ml,평균460 ml.소유환자균순리완성수술,무신경증상가중급의외발생.12례발생뇌척액루,여경척막련속봉합혹보편수보.2례거대형추간반돌출환자술후쌍하지기력감퇴,여격소、탈수、고압양급영양신경약물치료후기력축점회복.술후2주행X선검사시무내고정송동.수방시간14천지48개월,평균4개월.근거Otani등평분표준,우12례,량18례,가5례,차1례;림상우량솔83.3%.결론 후로추판절제감압、경관절돌관절추간반절제、추간식골융합병절단성내고정시치료하흉추추간반돌출증안전유효적술식.
Objective To evaluate the therapeutic effect of posterior laminectomy and transfacet discectomy combined with interbody fusion and segment fixation for the treatment of lower thoracic disc herniation.Methods From June 2000 to June 2010,36 cases of lower thoracic disc herniation were treated with method of posterior laminectomy and transfacet discectomy combined with interbody fusion and segment fixation,including 23 males and 13 females,with an average of 42 years old(range,22-61 years old).The courses of disease were from 21 days to 69 months,with an average of 22 months.The lesion locations were T10-11 for 12 cases,T11-12 for 15 cases and T12L1 for 9 cases.Each of the patients underwent X-ray and MR examination,31 of them underwent CT scanning.Twenty-five cases were central protrusion type,7 cases were para-central protrusion type,4 cases were lateral protrusionstype.The clinical results were evaluated by Otanni scored system.Results The operative time was 135-220 min,with average of 155 min.The blood loss was 350-800 ml,with average of 460 ml.All patients were successfully operated without neurological symptoms aggravation and accidents.Cerebrospinal fluid leakage occurred in 12 cases,which was treated by continuous suture or dura patch repair.Two cases with giant disc herniation suffered from muscle strength decrease of lower limbs after surgery,which gradually recovered after drug treatment of hormones,dehydration,high-pressure oxygen and nerve nutrients.Postoperative X-ray examinations showed that there were no internal fixation loosening.The followed-up period was 14 days to 48 months,mean 4 months.According to Otani scored system,there were excellent results in 12 cases,good results in 18 cases and poor results in 1 case.The clinical satisfaction rate was 83.3%.Conclusion Posterior laminectomy and transfacet discectomy combined with interbody fusion and segment fixation is a safe and effective surgical procedure for the treatment of lower thoracic disc herniation.