腰椎椎体后缘离断合并椎间盘突出症的手术治疗  

Surgical treatment of posterior bony separation and intervertebral disk herniation of lumbar vertebrae

作　　者：孟庆勇[1] 母心灵[1] 潘玉林[1] 

机构地区：[1]郑州市骨科医院脊柱科,郑州450052

出　　处：《医药论坛杂志》2011年第15期65-67,共3页Journal of Medical Forum

摘　　要：目的分析腰椎椎体后缘离断合并椎间盘突出症的发病机理，探讨手术治疗方法。方法2006年10月-2009年3月期间共手术治疗10例腰椎椎体后缘离断合并腰椎间盘突出症病人，男8例，女2例，年龄18—40岁，平均27岁。根据症状及CT检查显示骨块突出部位采取不同手术方式。4例单侧开窗，2例单侧半椎板切除，2例双侧开窗。2例采用一侧半椎板切除，另一侧开窗，6例切除了骨块，4例骨块未予处理。10例均手术切除突出的椎间盘组织。结果术后随访6～36个月，平均18个月。8例腰痛及下肢症状基本消失；2例偶有腰痛发作。但较术前减轻，其下肢症状消失；1例足下垂病人术后1月症状明显恢复，足背伸肌恢复到4级；2例马鞍区麻木患者感觉基本恢复正常。结论本病发病机理主要还是由于青少年时期椎体后缘环状骨骺变异或损伤逐步引起椎间盘突出的继发改变，最终造成神经根和硬膜囊的压迫。椎体后缘骨块仅部分参与神经根压迫，椎管内神经根及硬膜囊的彻底减压才能达到满意效果。Objective To investigate the possible reason and operative methods of posterior bony separation and lumbar intervertebral disk herniation. Methods A retrospective study was carried out on the clinical features, imaging studies and the operative methods of 10 patients with posterior bony separation and lumbar intervertebral disk herniation. 10 patients with posterior bony separation and lumbar intervertebral disk herniation, 8 males and 2 females ,aged from 18 -40 years, mean 27 years old, were operated from October 2006 to March 2009.10 patients were surgically managed by various ways according to clinical manifestations and CT scans, unilateral window casement lamina of vertebral arch 4 cases, half of laminectomy 2 cases, bilateral window casement lamina of vertebral arch 2 cases, half of laminectomy and unilateral window casement lamina of vertebral arch 2 cases. Ten intervertebral discs and six separated bodies were excised in the operative procedures, but four cases not. Results Follow - up 6 to 36 months, mean 18 months. Complete recovery was observed in 8 patients, except in 2 patients who still felt slight back pain. Conclusions The possible reason for the disease is both the bony separation and intervertebral disc herniation which might be a secondary changes of the injury or variance of the epiphyseal ring of the verterbral body during the adolescent period. The intervertebral disk herniation as the main reason and the bony separation as a partial reason lead to the central or root stenosis. Satisfactory results in its treatment can only be achieved after nerve tissue completely decompress.

关 键 词：腰椎 椎体后缘离断 椎间盘突出 手术治疗 

分 类 号：R681.5[医药卫生—骨科学]