腰椎峡部裂伴滑脱并腰椎间盘突出症临床研究

Clinical Study of Spondylolysis and Spondylolisthesis with Disc Herniation of the Lumbar Spine

目的 :探讨腰椎峡部裂伴滑脱并腰椎间盘突出症的发病机理、临床表现、治疗机理和疗效。方法 :回顾性分析该病 5 8例临床资料 ,用手法触诊检查确定腰椎棘突偏歪方向 ,5 8例患者全部摄了腰椎正侧、双斜位片 ,全部作了腰椎 CT或 MRI检查 ,用冯氏手法治疗了 5 8例患者。结果 :本组 5 8例均有棘突偏歪 ,以 L5为最多 ( 33个 ,5 5 .9% ) ;且棘突偏歪多发生在有峡部裂的椎骨棘突上 ( 4 6例 ,79.3% ) ;有间盘突出椎间隙的上位椎骨棘突上 ( 4 1例 ,70 .7% )。 CT或 MRI共检查了 1 98个椎间隙 ,在其中 6 2个变窄的椎间隙中发现 4 6个( 74 .2 % )椎间盘突出 ;在其中 1 36个正常的椎间隙中发现 4 2个 ( 30 .9% )椎间盘突出。单与多椎间隙椎间盘突出治愈例数比较 P<0 .0 5 ;腰椎滑程度 ( °与 °)治愈数比较 P>0 .0 5。结论 :本病确诊靠 MRI与 CT检查 。

Objective:To study the pathogenic mechanism,clinical manifestation and treatment of spondylolysis and spondylolisthesis with disc herniation of the lumbar spine.Methods:fifty eight cases were retrospectively analyzed with special clinical signs,the deviation of lumber spinous process assured by special palpation of Feng's Spinal Manipulation(FSM),radiographs in A P and lateral and oblique view, MRI or CT scanning on lumbar spine.Results:Deviation of fifth lumbar spinous process appeared to be the most frequently involved(33 cases 55.9%).46 out of 58 cases(79.3%) have a deviated spinous process just at the involved vertebrae of spondylolysis; and 41 out of 58(70.7%) cases have a deviated spinous process just above the involved intervertebral space with disc herniation.198 intervertebral spaces were scanned by MRI or CT.62 out of the total have the spaces narrowed with 46 dics herniation. There are 42 disc herniation occurred in the other intervertebral spaces with normal height. The patients with single disc herniation appeared with higher cure case compared with those with multible discs hernation (P<0.01).The slip degree(Ⅰ°and Ⅱ°) of vertebrae have insignificant effect on the result of treatment(P>0.05).Conclusion:A precise diagnosis of the disease is relied mainly on MRI or CT examination.The FSM is an effective choice in the treatment.