腰椎后缘骨突骨折（附14例临床病例分析）

Posterior Lumbar Apopbyseal Fracture(PLAF)

目的：椎间盘突出伴骨块在椎间突出症中并不少见，但对其发生机埋认识不一。作者就此进行了临床探讨。资料：本文报道１９９１～１９９４手术治疗的１４例（男１２，女２；１９～４４岁），其中５例有明显的外伤史。１２例表现为腰痛及神经根放射痛，下肢麻木无力，颇似但重于一般的椎间盘突出症１２例间歇性跛行，为椎管狭窄表现。Ｘ线平片及ＣＴ示椎体后缘有不规则或半月状骨片后移。７例在相邻层面有圆锥状缺损及周缘硬化等软骨结节样表现。结果：经扩大开窗或半椎扳，切除后移之骨块及椎间盘。病理证实骨片为椎体骨皮质。术后４～３７月随访，优１２例，良２例。结论：椎体后缘具有结构缺陷，又受相应剪切应力，导致骨折（病理及创伤），故建议命名为椎体后缘骨突骨折（ＰＬＡＦ）。由于骨块伴纤维环一起后移，突出物较一般的椎间盘突出大，症状重，一经确诊，多需手术切除。

Object:Extruded disc with bone piece is not so rare in lumbar disc disease,but the mechanlsm is not so clear. It was studied in our hospital. Materials:From 1991 to 1994, fourteen patients with PLAF(12male and 2 female,aged 14-44 years) were operated. There was a clear-cut history of lumbar included injury in 5 cases. The main clinical features low-back pain,sciatica,numbness and weakness in 12 patients as the findings of lumbar disc prolapse,and intermettent claudications as the symptomes of spinal stenosis in two. The characteristic signs of plain radiograms and CT scannings of the lumbar spine showed the posterior ramus pattern of free ir-ragular of semilunar bone fragment protruded posteriorly into the spinal canal.Seven cases with the characteristic signs of Schmorl's node in the next scanning. Results :All of the cases were oper-ated on with enlargment of the laminal fenstration or laminectomy,extracted the protruded mass.Histological findings were bony fragment together with the herniated disc tissue. The follow up pe-riod varied from 4 to 37 months,twelve cases excellent and two good.Conclusions:The authors be-leave that this disorders occured only in those patients with developmental defects and a special stress and suggest narned PLAF being accorded with the cause and mechanism of these disorders.Due to the presence of the fractured apophyseal of the body,so the size of protrusion can be unusu-aIly large and the clinical pictures severe than the usual disc prolapse. Surgical treatment should be selected early.