巨大型腰椎间盘突出症54例临床探讨

Clinical Study on 54 Cases of Magnum Protruded Lumbar Intervertebral Disc

目的探讨巨大型腰椎间盘突出症的发病机理、临床表现、治疗机理和疗效。方法回顾性分析该病54例临床资料,用手法触诊检查确定腰椎棘突偏歪方向,54例患者49例摄了腰椎正侧位片,全部作了腰椎CT或MRI检查,用冯氏手法治疗了54例患者。结果54例患者腰椎均有棘突偏歪,单(多)个椎体位移可能是该病的发病原因之一,巨大型腰椎间突出多发生在腰5骶1椎间隙(28例,51.9%)。巨大型的近期和远期、巨大型和普通型在治愈和有效率二组间无明显差异(P>0.05)。巨大型组手法治疗有效率96.3%。结论巨大型腰椎间盘突出的病理变化主要是椎骨小关节的错位,压迫和牵拉了相应的组织。非手术治疗的关键是纠正小关节的错位和恢复脊柱的内外平衡因素。确诊靠MRI和CT检查。

Objective： To study the pathogenic mechanism, clinical manifestation, treatment mechanism and therapeutic effect on magnum protruded lumbar intervertebral disc（MPLID）. Methods： The clinical material of 54 cases was retrospectively analyzed and the deviation directions of lumbar spinous process were assured by the special palpation. Forty-nine out of fifty-four patients took X-ray photographs in A-P and the lateral view, and all the patients examined by MRI or CT, scanning on lumbar spine. Fifty-four patients accepted Fengs Spinal Manipulation （FSM） treatments. Result：Fifty-four patients had deviated lumbar spinous process, and the main cause may be the displacement of single or more lumbar vertebrae. MPLID appeared mostly on L5-S1 segment 128 cases 51.9%. As for the curative rate of this disease, there is no significant difference between the patients of MPLID in the near future and the faraway future, nor between the patients of magnum type and the common type （ P〈0.05 ）. The effective rate of the manipulation treatment for the magnum group is 96.3%. Conclusion：The pathological changes of MPLID patients are mainly due to the displacement, compressing and stretching on the corresponding tissues of vertebral small joints. The correction of the vertebral subluxation and the balance restoring of the spinal column is the key to the conservative treatment. A precise diagnosis of the disease is mainly relied on the MRI or CT examinations.