| 碎裂游离型腰椎间盘突出症的诊断与治疗 |
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投稿时间：2002-11-04 修订日期：2003-01-06
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| 作者 | Author | 单位 | Address | E-Mail |
| 张洪美 |
ZHANG Hongmei |
中国中医研究院望京医院,北京 100102 |
Department of Bone Joint, Wangjing Hospital of China Academy of Traditional Chinese Medicine |
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| 孙钢 |
SUN Gang |
中国中医研究院望京医院,北京 100102 |
Department of Bone Joint, Wangjing Hospital of China Academy of Traditional Chinese Medicine |
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| 张磊 |
ZHANG Lei |
中国中医研究院望京医院,北京 100102 |
Department of Bone Joint, Wangjing Hospital of China Academy of Traditional Chinese Medicine |
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| 赵铁军 |
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中国中医研究院望京医院,北京 100102 |
Department of Bone Joint, Wangjing Hospital of China Academy of Traditional Chinese Medicine |
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| 顾力军 |
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中国中医研究院望京医院,北京 100102 |
Department of Bone Joint, Wangjing Hospital of China Academy of Traditional Chinese Medicine |
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| 陈卫衡 |
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中国中医研究院望京医院,北京 100102 |
Department of Bone Joint, Wangjing Hospital of China Academy of Traditional Chinese Medicine |
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| 期刊信息：《中国骨伤》2003年，第16卷，第9期，第519-521页 |
| DOI：doi:10.3969/j.issn.1003-0034.yyyy.nn.zzz |
| 基金项目: |
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中文摘要:
目的:探讨碎裂游离型腰椎间盘突出症的临床和影像学特点、发病机制和治疗等问题。
方法:23例游离型腰椎间盘突出症病例,经手术证实为碎裂游离型者6例,总结其影像学特点、手术方式和术中所见,并将术中情况与影像学表现进行比较。
结果: 影像学表现按照胡有谷区域定位法,本组6例均属于Ⅱ、Ⅲ层面c、d域,在水平位分区上,多位于2、3区。6例中4例均在72 h内手术,术式为全椎板或半椎板切除。游离2块者5例,游离2块并脱出于后纵韧带外者1例。多位于神经根管内,游离髓核组织块均与神经根、硬膜或马尾神经粘连。经过平均19.7个月的随访,JOA腰痛评分平均由4.0分提高到21.7分。
结论:此类病例神经损害较为严重,应尽早手术。影像学诊断为脱出型或游离型较为容易,但诊断为碎裂性较为困难,术中应仔细探查,以防漏诊。2次或2次以上髓核游离而成为碎裂游离型是其发病机制,应视为腰椎间盘突出症的一种特殊类型。 |
| 【关键词】椎间盘移位 骨科手术方法 诊断 |
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| Diagnosis and treatment of the free comminuted fragments of herniated lumbar intervertebral disc |
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ABSTRACT
Objective:To investigate the characteristics of the special type of the free comminuted frag-ments(FCFs) of herniated lumbar intervertebral disc at clinic,imaging,pathogenesis and treatment Methods 6 cases of the FCFs in 23 cases of the free disc fragment of herniated lumbar intervertebral disc were reviewed, which had been proved during operation. Some aspects were described such as the characteristics of imaging, the Methods of surgery, the findings during the operation. Comparison of the imaging
Results:was compared with the finding of the operation.
Results:According to HU Yougu’s regional located classification, the FCFs located in Ⅱ,Ⅲ layers and c,d regions that were extruded or sequestrated on imaged diagnoses;in panel located in 2,3 region that had closed relation with nerve roots in anatomy. All cases were operated as soon as possible. Laminectomy or semilaminectomy were selected,and lateral recess and vertebral canal were enlarged. Per nuclear comminuted into two fragments in 5 cases, and the other cases not only comminuted into two fragments but also the rest disc extruded out of the posterior longitudinal ligament. The free nuclear material always adhered to the nerve root,dura or cauda equina.The JOA’s lumbar pain scores reached to an average of 21.7 from 4.0 after operation by an average of 19.7 months follow-up.
Conclusion:In these cases neural injuries are always severe,so surgical treatment should be considered as scon as possible. Free disc fragment can be diagnosed preoperatively by myelography, CT or MRI easily, but the diagnosis of FCF is difficult, so the surgeon should search completely for additional fragments to avoid missing during the operation. The mechanism of FCFs looks like that the nuclear sequestrates out of the disc in two times or more and it should be named as a special type of herniated lumbar intervertebral disc. |
| KEY WORDS Intervertebral disk displacement Orthopaedics operative methods Diagnosis |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 张洪美,孙钢,张磊,赵铁军,顾力军,陈卫衡.碎裂游离型腰椎间盘突出症的诊断与治疗[J].中国骨伤,2003,16(9):519~521 |
| 英文格式: | ZHANG Hongmei,SUN Gang,ZHANG Lei.Diagnosis and treatment of the free comminuted fragments of herniated lumbar intervertebral disc[J].zhongguo gu shang / China J Orthop Trauma ,2003,16(9):519~521 |
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