CAJ | 학술논문

目的：探讨后外侧入路减压、椎间植骨融合、椎弓根螺钉内固定手术治疗胸椎管狭窄症的疗效及安全性。方法：2006年1月～2012年3月，收治单节段腹侧压迫致胸椎管狭窄症患者22例，男14例，女8例，年龄33～69岁，平均53.5岁。病程1~18个月，平均6.7个月。椎间盘突出部位：T7/81例，T8/94例，T9/109例， T10/118例。术前脊髓功能Frankel分级：B级5例，C级11例，D级6例。所有患者均行后外侧入路减压、椎间植骨融合、椎弓根螺钉内固定手术。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2.5~5h，平均3.2h，出血量400~1800ml，平均800ml。2例患者术后即刻有短暂脊髓功能障碍加重，经及时给予甲基强的松龙冲击、消肿、营养神经等治疗，分别于术后8h及24h开始逐渐恢复，其余20例患者术后即刻脊髓功能较术前恢复。术后随访24～60个月，平均40个月。末次随访时所有患者神经功能均明显改善，Frankel分级：C级3例，D级6例，E级13例。根据Otani等分级标准，优13例，良6例，可3例；优良率为86.36%。所有患者均获得骨性融合，均无内固定物松动、断裂等并发症发生。结论：后外侧入路减压、椎间植骨融合、椎弓根螺钉内固定手术治疗胸椎管狭窄症可取得良好的临床疗效，操作安全，并发症少。
목적：탐토후외측입로감압、추간식골융합、추궁근라정내고정수술치료흉추관협착증적료효급안전성。방법：2006년1월～2012년3월，수치단절단복측압박치흉추관협착증환자22례，남14례，녀8례，년령33～69세，평균53.5세。병정1~18개월，평균6.7개월。추간반돌출부위：T7/81례，T8/94례，T9/109례， T10/118례。술전척수공능Frankel분급：B급5례，C급11례，D급6례。소유환자균행후외측입로감압、추간식골융합、추궁근라정내고정수술。채용Otani등평분계통진행술후료효평고병계산림상우량솔，평개치료효과。결과：수술시간2.5~5h，평균3.2h，출혈량400~1800ml，평균800ml。2례환자술후즉각유단잠척수공능장애가중，경급시급여갑기강적송룡충격、소종、영양신경등치료，분별우술후8h급24h개시축점회복，기여20례환자술후즉각척수공능교술전회복。술후수방24～60개월，평균40개월。말차수방시소유환자신경공능균명현개선，Frankel분급：C급3례，D급6례，E급13례。근거Otani등분급표준，우13례，량6례，가3례；우량솔위86.36%。소유환자균획득골성융합，균무내고정물송동、단렬등병발증발생。결론：후외측입로감압、추간식골융합、추궁근라정내고정수술치료흉추관협착증가취득량호적림상료효，조작안전，병발증소。
Objectives: To study the efficacy and safety of the posterolateral approach decompression and discectomy combined with interbody fusion and pedicle screw internal fixation for the treatment of the thoracic spinal stenosis. Methods: Twenty two cases with the thoracic spinal stenosis undergoing the posterolateral de-compression and discectomy combined with interbody fusion were included in this group. There were 14 males and 8 females. The age ranged from 33 to 69 years old, with an average of 53.5 years. The course of disease ranged from 1 month to 18 months, with an average of 6.7 months. The lesion was T7/8 in 1 case, T8/9 in 4 cases, T9/10 in 9 cases, T10/11 in 8 cases. Frankel grade B was noted in 5 cases, C in 11 cases and D in 6 cases. The clinical results were evaluated by Frankel grade and Otani score system. Re-sults: The operation time was 2.5-5 hours, with an average of 3.2 hours. The blood loss was 400-1800 ml, with an average of 800ml. 20 cases had immediate postoperative neurological improvement. 2 cases, who ex-perienced transient postoperative neurological deterioration, were treated with methylprednisolone, detumescence and nerve nutrition therapy in time, then recovered by degrees at 8 and 24 hours postoperative respectively. The followed-up period was 24 to 60 months(mean, 40 months). At final follow-up, all patients had some ex-tent of neurological improvement, with Frankel grade C in 3 cases, D in 6 cases, E in 13 cases. According to Otani score system, there were excellent in 13 cases and good in 6 cases. The clinical satisfaction rate was 86.36%. All cases reached bony fusion without instrument failure. Conclusions: Posterolateral decom-pression and discectomy combined with interbody fusion is a safe and effective procedure for the thoracic spinal stenosis.