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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:

06

期数:

2006年2期

页码:

125-128

栏目:

出版日期:

2006-02-20

文章信息/Info

Title:

Clinical study of the diagnosis of thoracolumbar disc herniations

作者:

齐强; 刘宁; 陈仲强; 郭昭庆

北京大学第三医院骨科,北京,100083

Author(s):

Qi Qiang;  Liu Ning;  Chen Zhongqiang;  et al.

Department of Orthopaedics, Peking University Third Hospital, Beijing 100083, China

关键词:

胸腰段椎间盘; 椎间盘突出症; 临床表现; 诊断

Keywords:

Thoracolumbar disc; 　Disc herniation; 　Clinical manifestation; 　Diagnosis

分类号:

R681.5+3

文献标志码:

A

摘要:

目的探讨胸腰段椎间盘突出症临床表现的特点与规律,提高胸腰段椎间盘突出症的诊断水平.方法回顾性分析1995年9月～2004年1月我院经X线、CT、MRI及手术证实的胸腰段椎间盘突出症65例的临床资料,并将其分为低位胸椎组(T10-11～T12L1)43例,高位腰椎组(L1-2～L2-3)16例,多节段突出组6例. 结果躯体感觉障碍89.2%(58/65)和下肢无力83.1%(54/65)是最多见的症状.9.2%(6/65)表现为上运动神经元损害,47.7%(31/65)表现为下运动神经元损害,43.1%(28/65)表现为上、下运动神经元混合性损害.仅3例为单根神经根损害,其余表现为多根神经或马尾神经的损害.腰背痛44.6%(29/65)和下肢无力40.0%(26/65)是最常见的首发症状.低位胸椎间盘突出以混合性运动神经元损害为主,占58.1%(25/43),易导致行走障碍、足下垂、下肢肌张力升高和病理征阳性;而高位腰椎间盘突出则以下运动神经元损害为主,占93.8%(15/16),易造成腰背、下肢疼痛及马尾神经损害.结论胸腰段椎间盘突出症的症状广泛、体征多样,当临床上存在以下情况时应高度怀疑胸腰段椎间盘突出症:①大腿前方、外侧或腹股沟部位出现感觉障碍者;②下肢无力,股四头肌、胫前肌肌力减退者(如足下垂);③下肢运动或感觉障碍范围广泛、不规则,缺乏根性分布特征者;④上、下运动神经元损害同时存在,或虽表现为下运动神经元损害,但难以用低位腰椎间盘突出症解释者.

Abstract:

Objective　To explore the clinical features of thoracolumbar disc herniations and to improve the quality of the diagnostic procedure.　M ethods　Clinical data of 65 patientswith thoracolumbar disc herniations confirmed by X-ray examinations, CT, MRI, and operations from September1995 to January 2004 were retrospectively reviewed. The 65 patientswere divided into three groups: lower thoracic disc herniations (T10-11~T12L1) in 43 patients, upper lumbar disc herniations (L1-2~L2-3) in 16 patients, andmultiple levels of herniations in 6 patients.　Results　Paresthesia and lower extremity weakness were the most frequent symptoms, with their occurrence proportions being 89. 2% (58/65) and 83. 1% (54/65), respectively. Among the 65 patients, 9·2% (6/65) showed the presentation ofuppermotoneuron involvement, 47. 7% (31/65) manifested symptoms of lowermotoneuron impairment, and 43. 1% (28/65) presented asmixedmotoneuron disorders. Neurologicaldeficitswere usually extensive and the cauda equino syndromewas commonly seen, while isolated radicular impairmentwas noticed only in 3 patients. Back pain (44. 6%, 29/65) and lower extremity weakness (40. 0%, 26/65) were the most common initial complaints. Lower thoracic disc herniations were characterized bymixedmotoneuron disorders at the occurrence proportion of58. 1% (25/43), with a tendency leading to ambulatory dysfunction, drop foot, increased lowerextremitymuscle tension, and positive pathologic reflexes. By contrast, mostupper lumbardisc herniationsweremanifested as lowermotoneuron disorders at the occurrence proportion of 93. 8% (15/16), with back pain, lower extremity pain, and the cauda equino syndrome frequently encountered.　Conclusions　The clinical presentation of thoracolumbar disc herniations is complicated with the large-scale distribution and diversity of the symptoms and the complexity of clinical signs. We put forward four circumstances underwhich a high suspicion of thoracolumbardisc herniationwas recommended:①if there is a sensory disturbance at the anteriorand lateralaspectof the thigh orat the groin area;②if there is a lowerextremityweakness, especially in the quadriceps and the tibialis anteriormuscle (drop foot);③ifan extensive and irregular range ofsensory andmotion disturbances exists, with a lack of typical radicular distribution; or④if there aremixedmotoneuron disorders, or lowermotoneuron disorders unexplained by lumbar disc herniations.

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