胸椎间盘突出诊断治疗.docVIP

胸椎间盘突出诊断治疗 　　【摘要】 目的 探讨胸椎间盘突出症的临床表现、诊断及手术效果。方法 回顾15例胸椎间盘突出症的临床特点及影像学改变、手术治疗方法。全椎板切除减压椎间盘摘除3例,侧前方或侧后方入路摘除椎间盘8例,全椎板切除侧后方入路摘除椎间盘4 例。结果 随访1~4年,手术优良率达80%。结论 物理学、CT 或MRI 检查对确诊与定位有重要价值。根据椎间盘突出的大小、位置等情况可选择其入路。侧前方或侧后方入路及全椎板切除侧后方入路摘除椎间盘是治疗胸椎间盘突出症的有效、较安全术式。 　　【关键词】胸椎间盘突出;诊断;手术治疗 　　 　　The diagnosis and treatment of thoracic disc herniation 　　 　　YANG Xin-jun.Department of Urology,The People’s Hospital in Ju County,ShanDong 276500,China 　　 　　【Abstract】 Objective To study the clinical manifestation,diagnosis and surgical results of thoracic disc herniation.Methods The clinical appearances from 15 cases with thoracic herniation were analyzed,to study their clinical feature and imaging data,instruct operative methods.Results The thoracic disc protrusion of 3 cases were resected with laminectomy through posterolateral approach.8 cases were removed transversoarthropediculectomy through posterolateral or costotransversectomy through anterolateral approach and 4 cases were resected with laminactomy and transversoarthropediculectomy.Results The following up period were from 1 to 4 years,excellent and good results were obtained in 80%of the patients.Conclusions Systematic examination,CT or MRI is valuable for the diagnosis of thoracic disc protrusion.Operative treatment is an effective safe way with posterolateral or anterolateral approach and both laminectomy and transversoarthropediculectomy for thoracic disc protrusion. 　　【Key words】Thoracic disc protrusion;Diagnosis;Surgical treatment 　　 　　DOI:10.3760/cma.j.issn 1673-8799.2010.06.37 　　作者单位:276500山东省莒县人民医院骨科 　　 　　胸椎间盘突出症发病率低,临床表现无特异性,症状体征变化较大,易延误诊断,有多种治疗方法。影像技术的发展提高了本病认识水平和正确诊断率。2005年6月至2009年5月本科手术治疗胸椎间盘突出症15例,回顾性总结报道如下。 　　1 临床资料 　　1.1 一般资料 本组共15 例,男10 例,女5 例,年龄26~65岁,平均48.3岁。病程7 d~3.2年。患者均为体力劳动者,其中4例为高处坠落伤,3例有背部摔伤史,2例为提携重物时发生,余无明显诱因。15个节段胸椎间盘突出症中,中央型9例,旁中央型6例。发生部位:T??8~9? 1例,T??9~10? 1例,T??10~11? 3例,T??11~12? 6例,T??12?L?1 4例。其中3例合并胸椎黄韧带骨化(OLF),2例合并胸椎后纵韧带骨化(OPLL)。 　　1.2 临床表现 5例起病较急,其中4例为高处坠落伤,另1例为提重物时扭伤,其余缓慢起病,渐进性加重。临