经关节突入路治疗脊柱前方胸椎退行性压迫性疾病的临床观察[摘要]目的旨在探讨经关节突入路治疗脊柱前方胸椎退行性压迫性疾病的手术方法、临床效果、安全性及意义。方法收集并选择于本院将行经关节突入路治疗脊柱前方胸椎退行性压迫性疾病患者28例，其中，13例胸椎间盘突出并钙化、10例胸椎后纵韧带骨化、3例胸椎后缘骨赘和2例强直性脊柱炎。所有患者均经临床表现、CT和MRI证实脊髓压迫的症状、病变的性质及类型，经关节突入路切除致压物并固定。术前及术后采用JOA进行评分，术后参照Epstein分级标准进行评定并随访，随访期6～24个月。结果术后6个月按照Epstein分级标准进行术后功能评定结果显示优9例，良13例，改善5例，差1例，优良率为78.57%。术后3个月及6个月JOA评分与术前对比差异具有统计学意义（P<0.05）。结论经关节突入路治疗脊柱前方胸椎退行性压迫性疾病，可有效的解除脊髓压迫症状，且临床效果及安全性值得肯定。[关键词]关节突入路；胸椎；退行性；压迫性疾病；临床观察[]R684[文献标识码]A[]1674-4721（2012）04（a）-0046-03Theclinicalobservationoftraus-facetjointsapproachtotreatspinedegenerativediseaseswithanteriorcompressionZENGLingyuan1XIAOZengming21.OrthopedicsDepartment,thePeople′sHospitalofLaibinCityinGuangxiZhuangAutonomousRegion,Laibin546100,China;2.OrthopedicsDepartment,theFirstAffiliatedHospitalofGuangxiMedicalUniversity,Nanning530021,China[Abstract]ObjectiveToanalyzethesurgicaltechniques,clinicaleffectiveness,safety,andsignificanceofthetraus-facetjointsapproachtotreatspinedegenerativediseaseswithanteriorcompression.MethodsCollected28patientswithtraus-facetjointsapproachtotreatspinedegenerativediseaseswithanteriorcompression.Therewerethoracicdiscprotrusionwithossificationin13cases，thoracicossificationofposteriorlongitudinalligamentin10eases,thoracicvertebraposteriorosteophytesin3cases,ankylosingspondylitisin2cases,Patientsbyclinicalmanifestations,CTandMRIconfirmedspinalcordcompressionsymptoms,thenatureandtypeoflesion,anteriorossifiedcompressionswerecutviaposterior-latemlapproachandfixed.AllthepatientsassessedwiththeJOAscoreandEpsteingradingstandards.Postoperativefollow-up,follow-upperiodof6-24months.ResultsAfter6monthsinaccordancewiththeEpsteingradingstandardspostoperativefunctionalassessmentshowedexcellent9cases,goodin13cases,improvein5cases,poorin1case,thegoodrateof78.57%.AfterthreemonthsandsixmonthsJOAscorewasstatisticallysignificantcomparedwiththepreoperative(P<0.05).ConclusionThetraus-facetjointsapproachtotreatspinedegenerativediseaseswithanteriorcompressioncaneffectivelyrelievespinalcordcompressionsymptomsandclinicalefficacyandsafetyshouldbeaffirmed.[Keywords]Articularprocessapproach;Thoracic;Degenerativediseases;Oppression;Clinicalobservations脊柱退行性疾病包括颈椎病、颈椎间盘突出症、胸椎后纵韧带骨化、胸椎间盘突出并钙化、胸椎后缘骨赘、颈椎管狭窄症、腰椎间盘突出症、腰椎管狭窄症和腰椎滑脱症等。引起脊柱退行性变及慢性损伤的主要原因为脊柱稳定性下降而造成应力分布不均所致部分结构持续承受过大[1]。在临床实践中所见到脊柱前方压迫性疾病早期发病症状大多比较隐匿，一旦出现临床症状到医院就诊，临床症状将会逐渐加重。因个体差异本病发病后轻重不一，严重者将会影响日常生活和工作，有症状的脊柱前方压迫性疾病一经确诊应尽早行手术治疗。脊柱退行性疾病具有致残率高、手术难度大及并发症较多等缺点，因此对于其手术方法仍然在不断的摸索中。对于脊柱前方退行性疾病的最直接的手术方法为前路手术，但因该手术具有创伤大、并发症多、骨块切除困难、多阶段手术范围大、植骨块融合困难及无法解除脊髓后方压迫等缺点而受到限制[2]。随着对脊柱退行性疾病的探索及手术技术的发展...