腰椎椎体后缘终板骨坏死症

Osteonecrosis of the Lumbar Posterior End Plate

目的 :探讨腰椎椎体后缘终板骨坏死症的发病机制和诊断治疗。方法 :2 1例病人 ,以腰腿痛症状为主 ,少数伴有间隙性跛行和马尾压迫症状 ,平均发病时间 4.5年。X线检查发现下腰椎管内有一与椎体后缘相连的小骨块 ,CT扫描清晰显示椎体后缘有类圆形或多囊状骨质缺损 ,周边形成硬化带 ,后方骨质凸入椎管内 ,或压迫硬膜囊或压迫神经根。MRI显示对应椎间盘大都呈严重退变状态。本组病人全部行手术治疗 ,将凸入椎管内骨质凿除和对应突入的椎间盘摘除 ,部分病人行手术节段的植骨融合和内固定。结果 :术中肉眼所见 ,切除的凸入骨质都与纤维环边缘相连在一起 ,骨缺损区为纤维软骨组织和骨性组织所充填。术后 2 1例病人均获随访 ,时间 6个月～ 3年 ,平均 18个月。 18例腰腿痛症状消失 ,3例有轻度腰痛 ,3例大小便功能基本恢复正常。结论 :腰椎受异常应力或过度活动或其它一些尚不明的原因引起椎体终板缺血性变性、坏死 ,终板内形成骨软骨性坏死缺损区 (Schmorl结节 ) ,终板缺损区四周骨软骨组织在压力作用下增生、硬化。向后增生的骨质凸入椎管压迫硬脊膜囊内马尾神经或腰神经根 ,导致了本病的发生。因此将本病命名为“腰椎椎体后缘终板骨坏死症”

Objective:To study the pathogenesis and diagnosis and treatment of the osteonecrosis of the lumbar posterior end plate. Method:There were 21 cases with this disease whose chief symptoms were low back and leg pain. Some patients had intermitten claudication or cauda equina syndrome. The average time were four years and six months. X ray films showed a bony piece from the lumbar posterior vertebra protruding into the spinal canal. CT scanning found a round like or multicystic bony defect with a dense peripheral margin in the lumbar posterior end plate which protruding into the spinal canal and compressing the lumbar nerve root or dura mater. MRI showed that corresponding lumbar disc presented severe degeneration. All cases were operated on. Bony piece protruding into the spinal canal and herniated disc material were removed.Bone grafting and internal fixation were performed in the same segment in some cases. Result: Both of substance of bone protruding into the spinal canal together with peripheral anulus fibrosis and fibrous cartilage tissue with bony material filling in end plate defect area can be seen macroscopically. All 21 cases were followed up for six months to three years,average 18 months. Low back and leg pain disappeared in 18 cases and light low back pain remained in 3 cases. All 3 cases with cauda equina syndrome resumed normal basically. Conclusion:Abnormal stress or overload or other causes lead to lumbar end plate avascular degeneration and necrosis,which appeared shape osteochondral necrosis defect area in end plate. The proliferation and sclerosis appeared in the peripheral osteochondral tissue of the defect area. Proliferating posterior bony margin of the lumbar end plate protruded into the spinal canal to compress nerve root or cauda equina,lead to symptoms and signs of osteonecrosis of the lumbar posterior end plate. The name of the disease as'osteonecrosis of the lumbar posterior end plate'can reflect its pathologic essence comparatively precisely.