儿童椎间盘突出症的手术治疗

目的评价儿童椎间盘突出症的临床、影像学特点及手术治疗的效果。方法对6例<14岁椎间盘突出症患者在保守治疗(避免剧烈的体育活动,口服非甾体类消炎镇痛药、肌肉松弛剂及物理治疗等)3个月无效、剧烈的疼痛和(或)神经功能障碍进行性加重的情况下均行手术治疗。结果术中证实5例为椎间盘突出,1例为椎间盘脱出,其中3例伴有环状骨骺分离。所有患者术后均进行18～93个月的随访,平均63个月。末次随访时所有患者症状均完全消失。JOA评分为10分5例,9分1例。按Kirkaldy-Willis标准所有患者均为优良。影像学检查未见有椎间隙高度下降,椎体终板及关节突关节也未见退变征象。结论儿童椎间盘突出症患者经保守治疗3个月症状未缓解或神经症状进行性加重者应考虑手术治疗。

Surgical Treatment of Intervertebral Disc Herniation in Children

Objective To estimate the clinical and imaging characteristics and the efficacy of surgical treatment in children with intervertebral disc herniation. Methods Six children with intervertebral disc herniation aged less than 14 years who had severe pain and （or） aggravated neurological dysfunction after failed conservative treatment （avoiding strenuous physical activity, oral non-steroidal anti-inflammatory drugs, muscle relaxants and physical therapy） for 3 months received surgical treatment. Results Among the 6 children, intervertebral disc herniation occurred in 5, intervertebral disc protrusion in 1, and annular epiphyseal separation in 3. Patients were followed-up for an average of 63 months （range 18 to 93 months） and all symptoms disappeared completely at last follow-up. The JOA score was 10 points in 5 cases and 9 points 1 case. All patients had excellent or good clinical outcomes by Kirkaldy-Willis. Imaging examination showed no decrease in disc space height and no signs of degeneration of endplate and facet joints. Conclusion Surgery treatment should be considered in children with intervertebral disc herniation when symptoms are not alleviated or neurological symptoms aggravate after conservative treatment for 3 months.