CAJ | 학술논문

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。
목적 총결요추추체후연골내연골결절(LPMN)소치요추관협착증적진단화치료특점，탐토유관적발병인소。방법대경수술증실적16례LPMN소치요추관협착증적림상표현、영상학특정、수술방식진행회고성분석총결。결과16례균유간헐성파행，10례요퇴통，직퇴태고시험양성4례。영상학검사견요추추체후하연골결손급유리골괴돌입추관내。채용단측추판확대개창+골괴절제술4례，우3례，량1례。쌍측추판확대개창+골괴절제술12례，우9례，량3례，수방1～5년。결론1、LPMN적형성가능시재연골판선천성결함적기출상，유우응력화창상적작용，수핵경결함파렬적연골판돌출도추체화골돌배지간，인기골돌배시탈、후이，최종골화。2、수술시궤유조유호，단측추판확대개창+골괴절제화쌍측추판확대개창+골괴절제위유효술식。
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.