腰椎椎体后缘离断症

目的 认识腰椎椎体后缘离断症的临床及影像学诊断依据,提出治疗及手术要点。方法 8例腰椎椎体后缘离断症的患者,术前被冠以腰椎间盘突出症合并软骨结节突出4例,后纵韧带骨化2例,2例临床诊断有腰椎椎体后缘离断症的存在,术中均见大小不等的与突出的椎间盘组织并不相连的浮动骨块。结果 8例病人全部手术治疗,术后疼痛症状消失。随访4～18个月,只有2例患者诉残留阴雨天腰部酸痛症状。结论 腰椎间盘突出症的患者在CT扫描见突出物合并有骨化块时,要仔细分析有无腰椎椎体后缘离断的现象。清晰的腰椎正侧位X线片,病椎间隙CT轴位扫描有助于术前诊断。卧床休息,一般不做牵引及推拿,手术宜采取椎板双侧开窗以求完整切除骨块。

Posterior Bony Edge Separation of the Lumber Vertebral Body

Objective To provide clinical and image diagnosis basis for the posterior bony edge separation of the lumber vertebral body. Methods Among the 8 cases of the posterior bony edge separation of the lumber vertebral body, 4 cases of pre - operative clinical diagnosis precede with protrusion of the intervertebral disk combined with cartilage tubercle, 2 cases of posterior ligaments ossification, only 2 cases of existence of posterior bony edge seperation of the lumber vertebral body, during the operation, small or big pieces of drifting bones can be seen disconnected with protrusive intervertebral disk tissue. Results All of 8 cases had been operated, after the procedure, complete pain relief was achieved in all cases. All of cases underwent 4-18 months follow- up, only 2 cases remain pain in the cloudy day or rain. Conclusion When protrusion is seen during CT scan among the cases of protrusion of the intervertebral disk combined with cartilage tubercle, careful analysis is needed to make sure whether there is the existence of posterior bony edge separation of the lumber vertebral body. A clear lumbar vertebrae positive side x - ray and CT scan on the diseased lumbar vertebrae interstice may conduces to the preoperative diagnosis. Recess in bed is needed instead of traction and massage. Operation on both sides of the vertebral lamina is recommended to completely remove the cartilage tubercle.