|
摘要 目的 探讨硬膜下腰椎间盘突出症的临床特点和治疗方法。方法 收集分析2015年10月至2016年12月我科诊治的4例硬膜下腰椎间盘突出症患者的临床资料,3例为嚢内性突出,1例为根内型突出。收集每一个病例的病史,重点专科查体结果,影像学报告结果,于术前及末次随访时记录疼痛视觉模拟评分(visual analogue scale,VAS)及日本矫形外科协会(Japanese Orthopaedic Association,JOA)评分(29分法)并计算神经功能恢复率,评价疼痛缓解情况及神经功能恢复情况,并进行文献回顾性分析。结果 2例患者术前影像学资料出现了环形强化征、硬膜内气体征等典型表现;4例病例均进行了手术治疗,手术方式均为后路腰椎椎板切除减压、椎间盘切除术。术中切开硬膜,可见游离的髓核在硬膜囊内或神经根袖内,将游离的髓核与神经纤维分离,切除突出的间盘组织,切开的背侧硬膜予以严密缝合。所有患者术后JOA及VAS评分均有明显改善。结论 硬膜下腰椎间盘突出症相对少见,易与硬膜内髓外肿瘤相混淆,术前明确诊断相对困难,增强MRI检查是较为有效的检查方法;手术治疗可获得满意的效果。
|
|
关键词 :
硬膜下腰椎间盘突出症,
增强MRI,
马尾综合征
|
|
通讯作者:
王欢
|
作者简介: 李成(1987-),男,医师,中国医科大学附属盛京医院脊柱外科,110004。 |
[1]D'andrea G,TrillòG,Roperto R,et al.Intradural lumbar disc herniations:the role of MRI in preoperative diagnosis and review of the literature[J].Neurosurg Rev,2004,27(2):75-82.
[2]KoçRK,Akdemir H,Oktem IS,et al.Intradural lumbar disc herniation:report of two cases[J].Neurosurg Rev,2001,24(1):44-47.
[3]Schisano G,Nina P.Intraradicular lumbar disc herniation:case report and review of the literature[J].Neurosurgery,1998,43(2):400.
[4]Mut M,Berker M,Palaoglu S.Intraradicular disc herniations in the lumbar spine and a new classification of intradural disc herniations[J].Spinal Cord,2001,39(10):545-548.
[5]王海蛟,张铁良.囊内型和根内型椎间盘突出症[J].中国脊柱脊髓杂志,2002,12(3):224-226.
[6]Aydin MV,Ozel S,Sen O,et al.Intradural disc mimicking:a spinal tumor lesion[J].Spinal Cord,2004,42(1):52-54.
[7]Blikra G.Intradural herniated lumbar disc[J].J Neurosurg,1969,31(6):676-679.
[8]Lee JS,Suh KT.Intradural disc herniation at L5 S1 mimicking an intradural extramedullary spinal tumor:a case report[J].J Korean Med Sci,2006,21(4):778-780.
[9]Yildizhan A,Pasaoglu A,Okten T,et al.Intradural disc herniations pathogenesis,clinical picture,diagnosis and treatment[J].Acta Neurochir (Wien),1991,110(3/4):160-165.
[10]Jain SK,Sundar IV,Sharma V,et al.Intradural disc herniation-a case report[J].Turk Neurosurg,2013,23(3):389-391.
[11]Kobayashi K,Imagama S,Matsubara Y,et al.Intradural disc herniation:radiographic findings and surgical results with a literature review[J].Clin Neurol Neurosurg,2014(125):47-51.
[12]Ducati LG,Silva MV,Brandão MM,et al.Intradural lumbar disc herniation:report of five cases with literature review[J].Eur Spine J,2013,22(Suppl 3):S404-S408.
[13]Floeth F,Herdmann J.Chronic dura erosion and intradural lumbar disc herniation:CT and MR imaging and intraoperative photographs of a transdural sequestrectomy[J].Eur Spine J,2012,21(Suppl 4):S453-S457.
[14]Han IH,Kim KS,Jin BH.Intradural lumbar disc herniations associated with epidural adhesion:report of two cases[J].J Korean Neurosurg Soc,2009,46(2):168-171.
[15]Akhaddar A,Boulahroud O,Elasri A,et al.Radicular interdural lumbar disc herniation[J].Eur Spine J,2010,19(Suppl 2):S149-S152.
[16]钟远鸣,米琨,朱少廷,等.髓核突入硬膜囊内及神经根鞘内的腰椎间盘突出症的诊治[J].中国骨伤,2004,17(12):733-734.
[17]Lee HW,Kwon YM.Traumatic Intradural Lumbar Disc Herniation without Bone Injury[J].Korean J Spine,2013,10(3):181-184.
[18]Tamaki Y,Sakai T,Miyagi R,et al.Intradural lumbar disc herniation after percutaneous endoscopic lumbar discectomy:case report[J].J Neurosurg Spine,2015,23(3):336-339.
[19]Matsumoto T,Toyoda H,Terai H,et al.Utility of Discography as a Preoperative Diagnostic Tool for Intradural Lumbar Disc Herniation[M].Asian Spine J,2016,10(4):771-775.
[20]Liu CC,Huang CT,Lin CM,et al.Intradural disc herniation at L5 level mimicking an intradural spinal tumor[J].Eur Spine J,2011,20(Suppl 2):S326-S329.
[21]Choi JY,Lee WS,Sung KH.Intradural lumbar disc herniation--is it predictable preoperatively? A report of two cases[J].Spine J,2007,7(1):111-117.
[22]Shapiro S.Medical realities of cauda equina syndrome secondary to lumbar disc herniation[J].Spine (Phila Pa 1976),2000,25(3):348-352. |
|
|