腰椎椎体后缘骨内软骨结节所致腰椎管狭窄症的临床特征

目的　总结腰椎椎体后缘骨内软骨结节 (LPMN)所致腰椎管狭窄症的诊断和治疗特点 ,探讨有关的发病因素。方法　对经手术证实的 16例LPMN所致腰椎管狭窄症的临床表现、影像学特征、手术方式进行回顾性分析总结。结果　 16例均有间歇性跛行 ,10例腰腿痛 ,直腿抬高试验阳性 4例。影像学检查见腰椎椎体后下缘骨缺损及游离骨块突入椎管内。采用单侧椎板扩大开窗 +骨块切除术 4例 ,优 3例 ,良 1例。双侧椎板扩大开窗 +骨块切除术 12例 ,优 9例 ,良 3例 ,随访 1～ 5年。结论　 1、LPMN的形成可能是在软骨板先天性缺陷的基础上 ,由于应力和创伤的作用 ,髓核经缺陷破裂的软骨板突出到椎体和骨突环之间 ,引起骨突环撕脱、后移 ,最终骨化。 2、手术时机愈早愈好 ,单侧椎板扩大开窗 +骨块切除和双侧椎板扩大开窗+骨块切除为有效术式

Clinical Manifestation of Lumbar Spinal Canal Stenosis Caused by Lumbar Posterior Marginal Intraosseoos Cartilaginous Node

Objective To Summarize the diagnosis and treatnent of lumbar spinal canal stenosis caused by lumbar posterior marginal imtraosseous cartilaginous node (LPMN) and discuss its ralated pathogenic factors. Methods Sixteen cases of lumbar spinal canal stenosis caused by LPMN undergone sugical treatment from 1989 to 1999 were reviewed. Results Sixteen cases had intermittent claudication;10 cases had back and leg pain; 4 cases had position sign during the straight leg raising rest. Lateral X-ray film and CT scanning showed free bone fragments and defect of posteroinferior angles of the vertebrae. Sixteen cases were followed-up for 1～ 5 year. Four cases were treated with oneside openig window plus removal of bone fragment, 3 excellent result, and 1 good result. Twelve cases were treated with two side openig window plus removal of bone fragment, 9 excllent result and 3 good result. Conclusion 1. Procedure of LPMN is possibele to be base on congenital defect of intervertebral cartilage, uncleus pulposus herniate to between vertebral body and epiphyseal ring duing to stress and injury and cause tear and move of epiphyseal ring. 2. Surgical treatment is mandatory once LPMN is established. One side openig window plus bone fragment rescted and two side openig window plus fone fragment resected is effective surgical approach.