腰椎硬膜内型椎间盘突出症:文献综述及病案报告

Intradural Lumbar Disk Herniation:A Case Report with Review of Literatures

腰椎的硬膜内型椎间盘突出症(Intradurallumbardiskhemiation,ILDH)是一种少见的椎间盘退行性病变,近年来有零星报道。本文报道一例手术中确诊的ILDH。男性患者,50岁,左侧腰腿疼痛无力9月,加重伴左下肢麻木1月入院,神经检查发现左下肢肌肉萎缩,肌力减退,感觉减退,膝踝反射减弱,直腿抬高试验阴性,肛门感觉及反射正常。磁共振提示L3-4椎间盘突出,椎管狭窄。行L4椎板切除,椎管扩大减压,L3-4椎间盘摘除术。术中发现硬膜前方广泛粘连,突出的髓核穿透硬膜进入硬膜囊,纵行切开硬膜囊清除游离的椎间盘后,发现一个1.5×1.0×0.5cm3团块,神经根从其中穿出,病检提示为变情髓核。术中摘除L3-4椎间盘及占位团块。术后患者腰腿疼痛消失,术后2月下肢感觉肌力基本恢复正常。本文总结以往相关文献,对ILDH的流行病学特点,症状表现,影像特征及诊断治疗等方面进行讨论。

Intradural lumbar disk hemiation(ILDH)is a rare complication of degenerative disk disease which has been reported sporadially.This article reported a case of ILDH confirmed during operation.A 50-year male patient who had suffered the low back pain and left sciatica for 9 months with aggravation of symptoms and for 1 month was admitted.Neurological exam revealed atrophy of the muscles,weakness and sensory deficit of the left lower limb,decreased ankle and knee jerles,negative Lasegue's sign,normal sensation reflex over and area.Magnetic Resonance Imaging(MRI)revealed the L3-4 disk herniation and stenotic spinal cannel.The L4 laminectomy with removal of L3-4 disk was perfarmed.During the operation,there was extensue extradural adhesion observed.The herniated disk penetrated the dura sac.A longitudinal incision was made on the L3-4 dura sac and the never roots passed though a 1.5×1.0×0.5cm 3 mass which was extirpated and the pathological exam revealed the mass was a degenerated nucleus pulposus.The pain was immediately relieved after operation.Two months after operation,the patient was discharged with normal peusation muscle strength.The literature was reviewed and the epidemiological,symptomatic,imaging,diagnostic and therapeutic features of the Intradural lumbar disk herniation was discussed.