青少年腰椎间盘突出症并发椎体后缘骨离断的临床特征及外科处理

目的探讨青少年腰椎间盘突出症并发椎体后缘骨离断的临床特征及其手术效果。方法回顾1998年9月至2009年3月间收治的82例青少年腰椎间盘突出症患者(9～20岁,平均15.9岁)的临床和CT资料。其中A组22例并椎体后缘骨离断,分析其部位、大小和形态特征,手术同时切除突出髓核及离断骨骺;B组60例单纯腰椎间盘突出症中30例手术摘除突出髓核,30例非手术治疗。按日本整形外科学会评分(JOA)和疼痛视觉模拟计分(VAS)法,比较两组临床特征及手术效果。结果22例(28%)椎间盘突出合并后缘骨骺离断。JOA、VAS评分显示A组患者腰腿疼痛、神经功能状态均较B组患者严重(P0.05),而且手术前可以耐受保守治疗的时间也较B组患者短(P0.05);手术效果通过JOA、VAS评分比较两组无明显差异(P0.05),手术时间和手术出血量A组高于B组相应指标(P0.05)。结论青少年腰椎间盘突出症并发后缘骨离断者症状更严重,诊断明确应积极手术治疗,术中尽可能切除浮动、中央型体积较大或位于侧隐窝的离断后缘骨。

Clinical significance and surgical treatment of lumbar disc herniation associated with separation of the ring apophysis in adolescents

Objective To evaluate the clinical significance and surgical results of lumbar disc herniation associated with separated ring epiphysis in adolescents. Methods From September 1998 to March 2009, 82 cases(range 9～20y,mean 15.9 y)of adolescent lumbar disc herniation were reviewed by clinical data and CT. 22 cases of lumbar disc herniation associated with separated ring apophysis was group A. Location, size, and shape were analyzed. Discectomy and separate ring apophysis resection were carried out at the same time. 30 in 60 cases with disc herniation were group B, and discectomy was performed only. JOA and VAS were used for clinical evaluation. Clinical features and surgical outcomes were compared between group A and group B. Results 22 cases (28%) suffered from lumbar disc herniation associated with separated ring apophysis. Clinical symptom and neurological status of group A were more serious than that of group B according to VAS and JOA(P＜0.05). Pre-operative endurable periods of group A was shorter than that of group B significantly(P＜0.05). There was no significant difference between the two groups regarding post-operative results by JOA and VAS(P＞0.05). Operation time and blood lost were much higher in group A(P＜0.05). Conclusions Adolescent lumbar disc herniation associated with separated ring apophysis with more serious symptoms should be performed operation when diagnosis was determined. Bone block resection should be carried out when performing discectomy for sequestrated, large, central type, or lateral recess separated bone.