钙化型腰椎间盘突出症与腰椎间盘突出并椎体后缘离断症的诊断及手术治疗疗效分析

目的总结钙化型腰椎间盘突出症与腰椎间盘突出并椎体后缘离断症的诊断要点,探讨经椎间孔入路椎间孔镜下椎间盘切除术(percutaneous transforaminal endoscopic discectomy,PTED)在两种疾病治疗中的疗效。方法回顾性分析2015年11月至2017年11月在我院行PTED手术治疗的68例钙化型腰椎间盘突出症病人(钙化组)和22例腰椎间盘突出并椎体后缘离断症病人(后缘离断组)的临床资料,术前CT明确椎体后缘骨性结构情况,分析两种疾病影像学差异,通过腰腿疼痛视觉模拟量表(visual analogue scale,VAS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)、日本骨科协会(Japanese Orthopaedic Association,JOA)评分及改善率来评估近期手术疗效。结果 CT图像显示后缘离断组椎体后缘存在明显的骨缺损区域,椎体后缘骨块与骨缺损区域相对应,二者在形态上互补;钙化组的钙化组织一般呈点状或小片状分布于突出的椎间盘内部,椎体后缘没有骨缺损区域。病人均获得随访,随访时间为12～...

Diagnosis and treatment of calcified lumbar disc herniation and lumbar disc herniation with posterior edge separation of the vertebral body

Objective To summarize the gist of diagnosis of calcified lumbar disc herniation and lumbar disc herniation with posterior edge separation of the vertebral body,and explore the short⁃term efficacy of percutaneous transforaminal endoscopic discectomy(PTED).Methods From November 2015 to November 2017,68 patients with calcified lumbar disc herniation(calcification group)and 22 patients with lumbar disc herniation with posterior edge separation of the vertebral body(posterior edge disconnection group)were treated by PTED.Preoperative CT examination was performed to analyze vertebral posterior marginal osseous mass between different groups.The short⁃term efficacy was evaluated by visual analogue scale(VAS)of low back pain and leg pain,Oswestry disability index(ODI),Japanese Orthopaedic Association(JOA).Results CT image showed that in posterior edge disconnection group,there was an obvious bone defect area at the posterior edge of the vertebral body,and the bone block at the posterior edge of the vertebral body corresponded to the bone defect area,and the both were complementary in form.In calcification group,calcified tissue was usually scattered or patchy within the herniated disc,and there was no bone defect area at the posterior edge of the vertebral body.All patients were followed up for 12 to 24 months.The postoperative VAS score and ODI in the two groups were significantly improved as compared with those before operation(P<0.05).The JOA score in calcification group increased from 10.55±2.22 preoperatively to 26.77±3.67 postoperatively(P<0.05),and the improvement rate was 90.1%.The JOA score in posterior edge disconnection group increased from 9.45±3.45 preoperatively to 25.56±3.32 postoperatively(P<0.05),and the improvement rate was 85.1%.Conclusion Preoperative CT examination is very useful in the diagnosis of these two kinds of diseases,and the short⁃term efficacy of PTED is safe and effective.