CAJ | 학술논문

目的：探讨后路椎板减压髓核摘除侧后方植骨融合固定术治疗多节段胸椎间盘突症的临床疗效。方法18例多节段胸椎间盘突出症患者接受后路减压植骨融合术治疗。根据日本骨科协会(JOA)脊髓损害评分及Frankel分级系统评价手术效果。结果手术时间150~260min，平均190.6min；术中出血量430~1400ml，平均806.3ml；3例患者术中发生脑脊液漏，经加压包扎后愈合；1例术后发生伤口感染，给予敏感抗生素后伤口逐步愈合。局部Cobb角由术前的(18.7±4.1)°降低为术后3个月的(10.2±3.3)°及末次随访时的(11.3±3.6)°(P<0.05)。术后3个月及末次随访时JOA评分均较术前均有恢复(P<0.05)；末次随访时Frankel分级：B级3例，C级4例，D级5例，E级6例。术后随访14~35个月，随访期间无内固定物松动、移位及脊柱不稳发生。结论后路椎板减压髓核摘除侧后方植骨融合固定术是治疗多节段胸椎椎间盘突出症的有效术式，脊髓减压充分，脊柱稳定性可获得长久维持。
목적：탐토후로추판감압수핵적제측후방식골융합고정술치료다절단흉추간반돌증적림상료효。방법18례다절단흉추간반돌출증환자접수후로감압식골융합술치료。근거일본골과협회(JOA)척수손해평분급Frankel분급계통평개수술효과。결과수술시간150~260min，평균190.6min；술중출혈량430~1400ml，평균806.3ml；3례환자술중발생뇌척액루，경가압포찰후유합；1례술후발생상구감염，급여민감항생소후상구축보유합。국부Cobb각유술전적(18.7±4.1)°강저위술후3개월적(10.2±3.3)°급말차수방시적(11.3±3.6)°(P<0.05)。술후3개월급말차수방시JOA평분균교술전균유회복(P<0.05)；말차수방시Frankel분급：B급3례，C급4례，D급5례，E급6례。술후수방14~35개월，수방기간무내고정물송동、이위급척주불은발생。결론후로추판감압수핵적제측후방식골융합고정술시치료다절단흉추추간반돌출증적유효술식，척수감압충분，척주은정성가획득장구유지。
Objective To observe the therapeutic effects of posterior laminectomy and lateral bone fusion on multi-segments thoracic disk herniation. Methods 18 patients with multi-segments thoracic disk herniation accepted the posterior laminectomy and lateral bone fu-sion. They were followed up with JOA score and Frankel system. Results The mean of operative time was 190.6 min with a mean of blood loss of 806.3 ml. Cerebrospinal fluid leakage happened in 3 patients, and recovered after treatment. Wound infection occurred in 1 case and recovered after applied sensitive antibiotics. The Cobb's angle decreased after surgery (P<0.05). Compared with the preoperative, the JOA score improved 3 months later and at the last follow-up (P<0.05). During the follow-up, there was no fixation loosen, displacement and spi-nal instability happened. Conclusion Patients with multi-segments thoracic disk herniation may benefit full spinal decompression and a sta-ble spinal sagittal alignment from posterior laminectomy and lateral bone fusion.