小切口手术治疗腰椎椎体后缘离断症

Treatment by limited-incision for posterior edge separation of lumbar vertebral body

目的:探讨腰椎椎体后缘离断症的有效手术方法。方法:将腰椎椎体后缘离断症分为侧方型及中央型,采用椎板拉钩法的小切口手术治疗腰椎椎体后缘离断症12例,均为男性;年龄23～40岁,平均30岁;病程17.9个月。侧方型10例,其中离断骨块位于L4椎体后下缘1例,L5椎体后上缘3例,S1椎体后上缘6例,均合并同侧椎间盘突出;中央型2例,离断骨块均位于S1椎体后上缘。侧方型采用单侧椎板间开窗,摘除突出的椎间盘髓核,摘除椎体后缘骨块;中央型采用双侧椎板间开窗,摘除突出的椎间盘髓核,摘除椎体后缘骨块。结果:所有患者获得随访12～36个月,平均22.5个月,按照Macnab术后评定标准:优10例,良2例。结论:小切口手术治疗腰椎椎体后缘离断症具有手术创伤小、操作方便的优点,可完整摘除椎体后缘骨块,是一有效的手术方法。

Objective：To discuss effective operative method for posterior edge separation of lumbar vertebral body. Methods：Twelve cases of posterior edge separation of lumbar vertebral body were categorized as lateral type and central type, and were operated upon with limited-incision using lamina retractor. All patients were male and with an average age of 30 years （range,23 to 40 years）. The average history of disease was 17.9 months. In lateral type cases,separation bone was in the posterolateral lower edge of L vertebral body in 1 case, in the posterolateral upper edge of L5 vertebral body in 3 cases and in the posterolateral upper border of Si vertebral body in 6 cases ,all with ipsilateral disc herniation. Lateral type cases were treated with unilateral fenestration and removal of disc nucleus and posterior bony edge. Separation bone was in the central upper edge of S1 vertebral body with central disc herniation in 2 central type cases. Two central type cases were treated with bilateral fenestration and removal of disc nucleus and posterior bony edge. Results：All patients were followed up for 12 to 36 months,and the average follow-up was 22.5 months. According to Macnab postoperative evaluation criterion, the results were excellent in 10 cases,good in 2 cases. Conclusion：Limited-incision for posterior edge separation of lumbar vertebral body has characteristic of less trauma and convenience. It is an effective method for removal posterior bony edge.