腰骶神经根管非骨性段狭窄的动态影像学与临床研究

The clinical application and dynamic imaging study of the non-bony narrowed segment of lumbosacral nerve root canals

对临床具腰腿痛并脊髓造影显示单或双侧腰骶神经根影中断者，做了椎管斜位伸屈造影（３５例）和动态ＣＴＭ扫描（１３例），观察了根影动态变化。其中１７例术中加用伸屈腰椎拱桥探查了椎管前外侧角与神经根间关系。上述研究结果结合临床症状、体征发现：Ｌ５、Ｓ１神经根受椎管非骨性段挤压机会显著高于Ｌ４神经根。分析认为：常遇的腰骶神经根中断多发生在非骨性段的椎管前外侧角，椎间盘与黄韧带退变是神经根受压的主要病理因素，症状可随体位变动减轻或加重。斜位椎管造影和动态ＣＴＭ对判断不同狭窄节段与指导手术有重要参考价值。

The oblique flexion-extension myelography(35 cases) and dynamic CTM scans (13 cases) were performed on the patients with lumbocrural pain and lumbosacral nerve root block in the myelography. Changes of root imaging were observed. The relationship between anterio-larteral angle and nerve root in flexion or extension position of the lumbar spine during operation were explorated. It is discovered that L5 and S1 nerve root were more often compressed than L4 nerve root. Nerve root imagings changed its fluency with flexion or extension of the lumbar spine. The authors thought that lumbarsacral nerve root were of ten compressed in anterio-lateral angle of non-bony segment of lumbar canals. Degeneration of the soft tissue were main pathogenetic factor. The clinical symptoms were relieved or aggravated with position change.The dynamic oblique views myelography and dynamic CTM scans were worthy to judge narrowed segment and conduct the operation. (The Orthopedic Department of 85 Hospital, Shanghai 200052)