摘要目的 探讨经关节突入路治疗前方骨性致压型胸椎退行性疾患的手术方法和治疗效果.方法 2003年1月至2009年12月,收治前方骨性致压型胸椎退行性疾患患者22例,男16例,女6例;年龄36～72岁,平均54.2岁;胸椎后纵韧带骨化11例,胸椎间盘突出并钙化8例,胸椎后缘骨赘2例,强直性脊柱炎并胸椎假关节形成1例.患者均存在脊髓压迫症状,日本骨科协会(Japanese Orthopaedic Association,JOA)评分2～9分,平均5.2分;均经CT和MRI扫描明确胸椎退变的性质和致压物的类型.手术以揭盖法切除相应节段的棘突和全椎板,咬除双侧关节突关节,经侧后方人路切除脊髓前方的骨性致压物,椎间植骨、双侧椎弓根钉棒系统固定.结果 患者均获得随访,随访时间8～38个月,平均17.4个月.根据北京大学第三医院修订后的Epstein标准评定,优7例,良9例,改善4例,差2例;有效率90.9%(20/22),优良率72.7%(16/22).术后JOA评分为2～11分,平均8.7分.术中发生硬膜撕裂1例,胸膜损伤1例;术后发生硬膜外血肿压迫2例.无脊柱不稳和切口感染病例.结论 经关节突入路可彻底切除胸椎退行性疾患患者椎管前方骨性致压物,有效解除脊髓压迫.

abstractsObjective To investigate the clinical outcomes of trans-facet joints approach to treat thoracic degenerative disease with anterior compression.Methods From January 2003 to December 2009,22 patients with thoracic myelopathy caused by anterior compression were studied retrospectively.The patients included 16 males and 6 females,aged from 36 to 72 years(average 54.2 years).There were thoracic ossification of posterior longitudinal ligament(OPLL)in 11 cases,thoracic disc protrusion with ossification in 8 cases,thoracic vertebra posterior osteophytes in 2 cases,ankylosing spondylitis with thoracic pseudoarthrosis in 1 cases.Preoperative Japanese Orthopaedic Association(JOA)score was 5.2(range,2-9).The characteristic of thoracic degeneration was analyzed by CT and MRI examination.Posterior decompressive laminectomies were performed by the technique of "cap uncovering".The facet joints were removed bilaterally.Anterior ossified compressions were cut via posterior-lateral approach,and then intervertebral bone graft and bilateral pedicle screws were implanted.Results All patients were followed up for 8 to 38 months.According to the revised Epstein standard,there were excellent in 7 patients,good in 9,fair in 4,and poor in 2.The total effective rate was 90.9%(20/22).The excellent and good rate was 72.7%(16/22).The mean postoperative JOA score was 8.7(range,2-11).Surgical complications included dural laceration in 1 patient,pleura injury in 1 patient,epidural hematoma in 2 patients.There were no cases of spinal instability or deep infection.Conclusion The anterior compression can be solved completely via trans-facet joints approach in thoracic degenerative disease patients.