马尾神经根松弛症的临床诊断及治疗

CLINICAL DIAGNOSIS AND TREATMENT OF REDUNDANT NERVE ROOTS OF THE CAUDA EQUINA

本文报告马尾神经根松弛症（ＲＮＲ）１５例。介绍了ＲＮＲ的临床及椎管造影特点与诊断方法。根据其临床与病理特点，将ＲＮＲ分成三种临床类型：Ⅰ型：无临床症状，亦称无症状型，仅在造影时或尸检，手术中偶然发现，可不做特殊处理。Ⅱ型：有典型神经根受压症状，但无神经根、硬膜囊粘连，发病后经活动可缓解，需行手术扩大椎管，充分减压。Ⅲ型：临床症状较重，硬膜囊及马尾神经根有粘连，活动后难以缓解，手术需切开硬膜囊减压并松解粘连。本组平均随访３年，手术优良率７７％。还从临床角度探讨了ＲＮＲ的发病机制。

ifteen cases of redundat nerve roots of the cauda equina (RNR)are reported.Theclinical and myelographic characteristics and diagnosos of RNR are presented.Accordingto the clinical and pathological observations ,three type RNR are classified.Type Ⅰorthe asymptomatic type is usually identified incidentally in myelogram,autopsy or duringthe operation.No surgical intervention is needcd.Type Ⅱ has a typical feature of RNRwith no nerve roots and dura adhesion,therefore,its symptoms and signs may be reli-eved following moving about or jumping.Adequate decompressive laminectomy is nece-ssary to enlarge the spinal canal.Type Ⅲ is a more severe illness because of the con-strictive adhesion in dura and nerve roots.Both laminectomy and duratomy are neces-sary in this type.Satisfatory clinical results,with 77%oases in excellent or goodstate,are achieved during an average follow-up of three years.The pathogenesis of RNRis also discussed in relation to clinical aspects.