青少年腰椎间盘突出症的手法治疗及发病因素探讨

Treatment of Lumbar Disc Herniation in Adolescent by Manipulation and Discussion of Pathogenic Factors

目的：研究青少年腰椎间盘突出症的发病情况、临床特点、手法疗效及发病因素。方法：回顾分析我院收治的56例（发病率1．01％）青少年腰椎间盘突出症患者。男48例，女8例，年龄13～20岁，平均15．9岁；有明显腰部外伤39例（69．6％），有剧烈运动史36例（64．3％）；突出部位：L4.5 19例，L2S1 26例，L4.5和L2S1并存3例，中央型7例；影像学主要表现为间隙变窄；腰骶部先天变异；椎间盘中央髓核呈低信号．与纤维环分界不清甚消失。全部病例均行手法治疗，并对疗效进行评价。结果：随访34例，平均随访时间4，7年，优良率达85．3％。结论：①青少年腰椎间盘突出症发病男性明显高于女性，有腰部外伤和剧烈运动史；②体征和影像学改变比症状可靠。有的患者症状很少，但查体均有明显体征，主要表现为腰椎的反弓、侧弯等畸形改变，直腿抬举试验低于30°；③手法治疗的近远期效果满意，伴有先天腰椎管狭小是手术的绝对适应症。④椎间盘退变和外伤是造成青少年腰椎间盘突出症的关键因素，剧烈运动和腰骶部先天变异可能是导致椎间盘提早退变的主要原因。

Objective：to investigate the invasion circumstances,clinical characteristics , curative effect by manipulation and pathogenic factors. Methods：Fifty-six cases of lumbar disc herniation in adolescent, treated in hospital, were reviewed,the disease incidence is 1.01%. Among them,48 cases were male and 8 cases were female,ranging in age from 13 to 20 years （average 15.9 years）. 69.3% of them had apparent trauma and 64.3% of them had a history of strenuous exercise. Radiographic presentation mainly showed narrowing of intervertabral spaces, Iumbosacral congenital variation and low signal in disc nucleus pulposus, unclear or disappearance with the textile fiber link. All patients were treated by manipution and evaluated the curative effect. Result：Thirty four patients were followed up for an average of 4. 7 years. The execellent and good rate was 85.3%. Conclusion：（1）Themale was obviously higher than female in the disease incidence,used to haveahistory of trauma and strenuous exercise. （2）Physical signs and radiograghic imaging are more reliable than symptoms, some patients have few symptoms but all patients have apparent physical signs, lateral curvature and reverse of the physiological curve often been seen,the straight leg lifting test always proved to be strongly positive. （3）It is satisfied with near and late curative effect by manipulation,but the patients with congenital spinal stenosis is not good. （4）Retrograde degeneration of disc and trauma are the pivotal factors of lumbar disc herniation in adolescent, strenuous exercise and congenital variation of lumbosacral region are possibly important causes lead to degenerate prematurely.