腰椎椎体后缘骨软骨病的临床特点与手术治疗

Clinical characteristics and surgical treatment of the osteochondrosis of lumbar posterior vertebral edge

[目的]探讨腰椎椎体后缘骨软骨病（osteochondrosis oflumbar posterior vertebral edge，OLPV）的临床特点、手术方法及疗效。[方法]回顾分析2000年8月-2003年8月间接受手术治疗并获随访的OLPV患者41例，所有患者均在后路充分减压基础上选择性行间盘、后突骨块或问盘＋骨块切除，1例伴腰椎失稳且减压范围较大者行椎弓根内固定并椎间植骨。[结果]41例患者术后腰腿痛症状均完全或明显改善，仅4例部分残留下肢感觉、运动障碍，术后病理均提示符合骨软骨病特点；随访5～8年（平均6．8年），6例诉偶有腰痛但程度多较轻未影响日常生活；全部病例未见腰椎失稳表现；内固定组未出现螺钉松动、拔出。患者术前JOA腰痛疾患疗效评分为（14．73±2．06）分，术后3个月时评分（27．144-4．13）分，两者间存在显著性差异（P〈0．05）；终末随访时为（26．584-2．23）分，与术后3个月时相比差异无显著性（P〉0．05）。终末随访时手术满意程度：优35例，良3例，可3例，差0例，优良率为92．7％。[结论]OLPV主要表现类似腰椎间盘突出及腰椎管狭窄症但又有其自身特点；影像学特别是CT检查在诊断及指导治疗中具有重要意义；神经压迫严重或伴有髓核疝出时需尽早手术治疗；术中需在充分显露并尽可能保证脊柱稳定性基础上根据具体情况选择性切除致压物，通常无需内固定或植骨融合。

[ Objective] To study the clinical characteristics of osteochondrosis of lumbar posterior vertebral edge （OLPV） and evaluate the efficiency of surgical treatment. [ Method] From August 2000 to August 2003, 41 cases of OLPV patients were treated, all cases underwent decompression of posterior approach and selective resection of the compressive things. Furthermore, 1 case was treated with trans - vertebral pedicle internal fixation and inter - transverse process bone graft because of excessive decompression and preoperative lumbar instability. [ Result ] Low back and leg pain disappeared or obviously being relieved in all cases, and the results of histological analysis suggested the diagnosis of OLPV in all cases. Forty - one cases were followed from 5 to 8 years, average 6. 8 years. No lumbar instability or spondylolisthesis was found in any case. Six cases suffered slight low back pain occasionally without obvious impaired quality of life. The preoperative JOA score was 14.73 ± 2.06, when followed by 3 months, the score changed into 27.14 ± 4. 13, there was statistical significance between them （P 〈 0. 05） . At the end of follow - up, the JOA score was 26. 58 ± 2. 23 without significant difference compared with cases of 3 months postoperative. And excellent and good results were obtained in 38 cases （92. 7% ） . [ Conclusion] The patients are usually young and manifested with the sign and symptom of lumbar disc herniation and/or lumbar stenosis, while their own characteristics still existed. CT is important for the accurate diagnosis of this disease. Surgery should be selected as soon as possible on the cases that had severe symptoms or combined with disc hernation. The decompression should be adequate while preserving the utmost integrity of the posterior lumbar structures. Bony piece protruding into the spinal canal ＇and herniated disc material must be removed selectively according to the type and range of protrusion. Internal fixation and bone grafting are not necessary in most cases. The results were satisfying usually.