腰骶椎椎体后缘离断症的手术治疗

Surgical treatment for the posterior rim separation of the lumbar and sacral vertebral boday

中文关键词:  腰椎  骶椎  椎体后缘离断  手术治疗

英文关键词:Lumbar vertebrae  Sacral vertebrae  Posterior rim separation  Surgery

中文摘要:

  【摘要】 目的：探讨腰骶椎椎体后缘离断症的临床治疗方法及疗效。方法：2004年2月～2010年6月共收治腰骶椎椎体后缘离断患者34例，行X线、CT、MRI检查确诊。均行游离骨块及相应节段椎间盘切除。先行椎间盘切除，扩大椎间隙，构建与离断骨块相适应的沟槽，采用咬、刮、凿等技术切除骨块。Takata分型中13例Ⅲ型离断患者行扩大开窗或半椎板切除。Ⅰ、Ⅱ型离断患者，单侧出现神经根症状者行患侧扩大开窗或半椎板切除11例；双侧出现神经根损害者行双侧开窗5例；椎管狭窄明显、伴有椎体滑脱行全椎板切除5例。若离断骨块较大，侧隐窝狭窄，脊柱不稳患者同时行后路腰椎椎体间融合术（posterior lumbar interbody fusion，PLIF）11例。随访时摄正侧位X线片观察植骨融合情况，应用腰椎JOA评分系统评价近期疗效。结果：随访11个月～4.6年，平均2．7年，术前JOA评分平均12.4分，末次随访时平均27.2分，除1例Ⅱ型、1例Ⅲ型离断患者外，其他患者均获得满意疗效，优良率94%。未出现术中术后并发症，植骨均融合。结论：椎体后缘离断症经保守治疗无效者应尽早手术治疗。正确的术前诊断及对离断骨块类型、位置的准确掌握及切除是外科手术成功的关键。 【关键词】 腰椎；骶椎；椎体后缘离断；手术治疗

英文摘要:

  【Abstract】 Objectives: To evaluate the therapeutical methods and clinical effects for posterior vertebral rim separation of lumbar and sacral vertebral boday. Methods: From February 2004 to June 2010, 34 patients underwent lumbar radiography, computed tomography (CT), and magnetic resonance imaging (MRI). All patients were operated on discectomy and removal of the bony fragments. First, doing disectomy and providing an evacuated interspace, a trench was created around the fragment at the interspace. The resection of bony fragments was proceeded using the laminectomy rongeur, curette and small chisel. Wide fenestration or hemilaminectomy was performed for 13 type Ⅲ lesions. For 11 typeⅠ, Ⅱ lesions that the nerve root symptoms were unilateral, wide fenestration or hemilaminectomy was applied to the trouble side；for 5 cases with bilateral symptoms, bilateral fenestration was applied to both sides；for 5 cases with large bony fragment, spinal canal stenosis and lumbar spondylolisthesis were treated with laminectomy, posterior lumbar interbody fusion(PLIF). JOA score was used to evaluate the short-term clinical results. Results: The follow-up period ranged from 11 months to 4.6 years (mean 2.7 years). The average lumbar JOA score of pre-operation and the last follow-up was 12.4 and 27.2, respectively. Satisfactory effect was achieved in all patients except one typeⅡand one type Ⅲ lesion, the satisfaction rate of the clinical results was 94%. There were no serious intra-operative or postoperative complications. Patients undergoing PLIF had bony fusion at final follow-up. Conclusions: Early operation should be applied to patients who got no effects by conservative treatment. Preoperative accurate diagnosis and understanding the type and location of the separated fragment are the essentials for surgical success.