腰椎Scheuermann病(附5例报告)

Lumbar Scheuermann disease:5 cases report

押目的探讨腰椎Scheuermann病的病因、发病机制和诊断与治疗。方法共收治5例患者,全部表现为严重下腰痛,X线片示腰椎1-2个椎间隙上下终板不规则,Schmorl结节形成,椎间隙狭窄,对其进行椎间盘造影和腰椎前路植骨融合术。术中将椎体上下终板和其下的薄层松质骨一并切下,进行常规病理组织学检查。结果Scheuermann病发生的椎间隙其椎间盘造影试验阳性。5例病人术后随访6～20个月,平均12月。4例术后腰痛症状消失,1例仍有腰痛,但较术前明显减轻。X线片上显示的终板不规则和Schmorl结节在组织学上实际上是终板和终板下松质骨的骨坏死。结论腰椎Scheuermann病的发病机制实质上是椎体软骨终板下的骨坏死。腰椎Scheuermann病手术治疗具有良好临床效果,腰椎间盘造影术阳性是确保手术成功的关键。

Objective To study the pathogenesis and the diagnosis and treatment of lumbar Scheuermann disease. Methods 5 cases with severe low back pain were treated. Lumbar radiographs showed the irregularities of the endplates and the space narrowing and the presence of Schmorl's nodes in 1-2 disc spaces in where discography and anterior intervertebral body fusion were undertaken. The superior and inferior endplates were removed for histological examination. Results Discography presented positive reaction in the disc spaces of Scheuermann disease. 5 cases were followed-up for 6-20 months, averaged 12 months. Low back pain disappeared in 4 cases, obviously alleviated in 1 case. Histological examination showed the osteonecrosis in the endplates and underlying spongy bone. Conclusion Pathogenesis of Scheuermann disease in fact is the osteonecrosis of underlying cartilaginous endplate. Operation is an excellent treatment method. Discography before operation is necessary.