腰椎间盘突出合并椎体后缘离断症的治疗

Clinical study of the treatment to lumbar disc herniation with posterior edge separation of the vertebral body

目的探讨腰椎间盘突出合并椎体后缘离断症的临床治疗方法。方法腰椎间盘突出合并椎体后缘离断患者31例,男24例,女7例;年龄18～61岁,平均32.6岁,20～40岁者占64.5%。2例采用保守治疗,其余29例根据离断骨块﹑突出椎间盘与椎管的关系选择术式。偏一侧者行患侧开窗或扩大开窗摘除致压物,呈中央型或旁中央型者行双侧开窗摘除致压物,累及椎管前方大部者行后路腰椎椎体间融合术(posteriorlumbarinterbodyfusion,PLIF)或经椎间孔腰椎椎体间融合术(transforaminallumbarinterbodyfusion,TLIF)。结果全部病例随访1～4年,平均2.6年。1例保守治疗无效者改行患侧开窗减压术。离断骨块和突出椎间盘偏一侧者6例术后均获显效;中央型或旁中央型者10例术后总体恢复率仅为60%,未恢复及术后症状加重者再行PLIF而获明显改善;累及椎管前方大部者13例术后均获得满意疗效。结论腰椎间盘突出合并椎体后缘离断症经保守治疗无效者应尽早手术治疗。病变偏一侧者可行患侧开窗或扩大开窗摘除致压物;中央型或旁中央型者若突出物占位椎管以旁侧为主且该侧无明显侧隐窝狭窄时可行双侧开窗减压,若突出物占位椎管以中央为主或存在明显侧隐窝狭窄时应行PLIF或TLIF;累及椎管前方大部者应行PLIF或TLIF。

Objective To investigate therapeutical methods on lumbar disc herniation with posterior edge separation of the vertebral body. Methods Different methods were applied to 31 patients, including 24 males and 7 females whose ages ranged from 18 to 61 years. Except that 2 patients with mild lumbar pain were treated with conservative therapy, the other 29 patients were treated with operation. The operations were made according to the relationship between compressive hernia and vertebral canal. For instance, for cases that the herniated mixtures were lateral, decompression with fenestration or amplified fenestration was applied to the trouble side; for cases that mixtures were central or paracentral, the same treatment was applied to both sides; and posterior lumbar interbody fusion （PLIF） or transforaminal lumbar interbody fusion （TLIF） was applied to those that the mixtures occupied most part of the front canal. Results The follow-up studies were made for all the patients for 1 to 4 years with an average period of 2.6 years. For the two patients treated with conservative therapy, one was fully recovered and the other, who took no effect from former therapy, was finally recruited after decompression with fenestration on the trouble side. Among the patients who were treated with operation, those with lateral herniated mixtures received significant effect, while only 60% of those with central or paracentral mixtures recovered （the unrecovered or even worsened patients after operation finally recruited by PLIF）, and for those with mixtures occupying most part of the front canal, satisfactory effect were achieved. Conclusion Operation treatment should be applied to patients as early as possible when conservative therapy has no obvious effect. Different operation methods should be taken according to the relationship between compressive hernia and vertebral canal： 1） Decompression with fenestra- tion or amplified fenestration on the trouble side be applied to those with lateral herniated mixtures; 2） Decompression with fenestration on both sides be applied to those with paracentral mixtures but no lateral crypt narrowness, and PLIF or TLIF to those with central mixtures or lateral crypt narrowness; 3） PLIF or TLIF be applied to those with mixtures occupying most part of the front canal.