Lonstein J E
Dept. of Orthopaedic Surgery, University of Minnesota, Minneapolis.
Basic Life Sci. 1988;48:283-92. doi: 10.1007/978-1-4684-8712-1_38.
In summary, neurological symptoms in the achondroplast are related to the anatomical spinal canal with degenerative changes and aging altering the delicate biomechanical and microvascular balance. An accurate and detailed history is necessary for diagnosis. Decompression is via a posterior approach with a multi-level wide laminectomy with undercutting of the facets and usually multi-level foraminotomies. Kyphosis when present at the time of decompression, or if angular or progressive, requires treatment. A combined two-stage approach with an anterior disc excision and fusion combined with a posterior and posterolateral fusion is the treatment of choice. In angular deformities anterior strut grafting is indicated. The use of instrumentation posteriorly is contraindicated with the possible exception of transpedicular fixation. The instrumentation stabilizes the spine and does to correct the deformity. Using this approach the kyphosis in the achondroplast and the symptomatic spinal stenosis are adequately treated.
总之，软骨发育不全患者的神经症状与解剖学上的椎管有关，退变改变和衰老会改变脆弱的生物力学和微血管平衡。准确而详细的病史对诊断至关重要。减压通过后路进行，采用多级广泛椎板切除术，对小关节进行咬除，通常还需进行多级椎间孔切开术。减压时若存在后凸畸形，或后凸呈角状或进行性发展，则需要治疗。首选的治疗方法是两阶段联合手术，即前路椎间盘切除融合术与后路及后外侧融合术相结合。对于角状畸形，需进行前路支撑植骨。除可能的经椎弓根固定外，禁忌在后路使用内固定器械。内固定器械可稳定脊柱，但不能纠正畸形。采用这种方法，软骨发育不全患者的后凸畸形和有症状的椎管狭窄可得到充分治疗。
