胸椎椎体后缘骨内软骨结节的发生特点与手术治疗

Clinical features and surgical treatments of thoracic posterior marginal intra-osseous cartilaginous node

目的探讨胸椎椎体后缘骨内软骨结节的特点以及软骨结节切除术与改良全脊髓减压术的疗效。方法1978年5月至2005年5月，手术治疗胸椎椎体后缘骨内软骨结节32例，男18例，女14例；年龄23-70岁，平均47．8岁。X线片可见损伤终板后上或后下缘的骨赘、游离骨块、缺损；CT轴位片可见突向椎管的环形或块状骨化影，其内为低密度区；MRI可见脊髓受压，但无法分辨骨性终板与软骨终板。前20年的6例分别采用传统全椎板减压术、侧前方减压术、整块半关节突全椎板减压术治疗各2例；后6年采用软骨结节切除术治疗21例、改良全脊髓减压术治疗5例。结果32例中31例发生于胸腰段、1例位于Tg。共发生胸椎椎体后缘骨内软骨结节37处，椎体上终板30处、下终板7处；单一椎体终板发病者27例、相邻椎体上下终板同时发病者4例、跳跃性两处发病者1例。32例中合并胸椎黄韧带骨化者16例，7例与胸椎椎体后缘骨内软骨结节发生于同一椎间、9例发生于与软骨结节上下相邻及其以远椎间。黄韧带骨化按CT分型，棘状型与结节型11例、板块型与隆突型5例。随访26例，随访时间1-27年，平均3．8年。按Otanni分级方法，优22例（84．6％）、良3例（11．5％）、可1例（3．9％）。结论胸椎椎体后缘骨内软骨结节多发于胸腰段椎体的上终板，且常常合并胸椎黄韧带骨化；软骨结节切除术与改良全脊髓减压术是治疗该病的安全、有效术式。

Objective To study the features of thoracic posterior marginal intra-osseous cartilaginous node and compare the clinical results between the excision of cartilaginous node and modified total decompression of the spinal cord. Methods From May, 1978 to May, 2005, totally 32 cases of thoracic posterior marginal intra-osseous cartilaginous nodes were treated with surgical operations. There were 18 males and 14 females with the average age of 47.8 years （23-70）. In early 20 years 2 patients were treated with traditional laminectomy, 2 with lateral-anterior decompression and 2 with decompression with en bloc hemiarticular process laminectomy; in later 6 years, 21 cases were treated with the excision of cartilaginous node and the remaining 5 cases treated with modified total decompression of the spinal cord. Results Among the 32 cases, 31 had the focus at the thoracic and lumbar section and one at Tg; totally 37 thoracic posterior marginal intra-osseous cartilaginous node were involved, including 30 at the superior end-plate and 7 in inferior end-plate. Of the 32 cases, 16 also accompanied with ossification of ligamentum flavum of thoracic vertebra; 7 happened in the same intervertebra with thoracic posterior marginal intra-osseous cartilaginous node, others in the intervertebra adjacent or noncontiguous to the ones with cartilaginous node. The mean follow-up period to 26 cases was 3.8 years with a range from 1 to 27 years. In accordance with the criterion set by Otanni, the clinical results of 22 were excellent （84.6%）, 3 good （11.5%）, 1 fair （3.9%） and bad 0. Conclusion Thoracic posterior marginal intra-osseous cartilaginous node commonly occur at the superior end-plate of vertebral bodies in thoracic and lumbar section and often accompanied by the ossification of ligamentum flavum and the excision of cartilaginous node and modified total decompression of the spinal cord have been proved as the safe and effective operative approach for the treatment of the disease.