钙化型腰椎间盘突出症与椎体后缘离断症鉴别和临床处理若干问题的探讨

Clinical study of the differential diagnosis and treatment for calcified lumbar disc herniation and posterior bony edge separation of the vertebral body

目的探讨钙化型腰椎间盘突出症与腰椎体后缘离断症的发病机制、手术时机、临床表现、影像学检查、术式选择的特点,以明确鉴别要点,指导临床诊断及治疗。方法研究对象为脊柱科自2011年7月至2013年6月收治的钙化型腰椎间盘突出症患者45例(A组)、椎体后缘离断症的患者40例(B组),随访时间均为1年,临床资料完整。两组均保守治疗无效后行手术治疗,对比两组患者的临床表现、发病机制及手术时机、影像学检查及术式选择。结果 A组患者术前JOA评分平均11.8分,术后1年评分平均25.58分;其中优36例(80.00%),良2例(4.44%),可7例(15.56%)。B组患者术前JOA评分平均12.67分,术后1年评分平均27.12分;其中优34例(85.00%),良6例(15.00%),总优良率为100%。结论钙化型腰椎间盘突出症与腰椎体后缘离断症临床表现相似,发病机制及手术时机、影像学检查、术式选择各有其特点,临床上要避免漏诊、误诊,并根据实际情况制定最佳手术方案。

Objective To investigate pathogenesis, operation timing, clinical characteristics, image manifestations, the selection of surgery for calcified lumbar disc herniation and posterior bony edge separation of the vertebral body in order to direct clinical diagnosis and treatment. Methods Forty - five cases of calcified lumbar disc herniation （ group A） and 40 eases of posterior bony edge separation of the vertebral body （group B） treated in the hospital from July 2011 to June 2013 were enrolled in this study. Patients received surgery after ineffective conservative treatment in both groups and the patients were followed- up for 12 months after surgery. The pathogenesis, clinical characteristics, radiographic diagnosis and operation method were compared between two groups. Results The mean preoperative JOA score of group A was 11.8 points and the mean postoperative JOA score was 25.58 points. Treatment outcomes for patients in group A were excellent in 36 （ 80.00% ） , good in 2 （4. 44% ）, and poor in 7 （ 15.56% ）. The mean preoperative JOA score of group B was 12.67 points and the mean postoperative JOA score was 27. 12 points. Treatment outcomes for patients in group B were excellent in 34 （ 85.00% ）, and good in 6 （ 15.00% ）. Conclusion Calcified lumbar disc herniation and posterior bony edge separation of the vertebral body are similar in clinical characteristics, but different in pathogenesis, op- eration timing, image manifestations and the selection of surgery, we should avoid missed diagnosis and misdiagnosis and determine the best strategy for patients.