腰椎间盘突出症的临床与手术的关系

The relevance between the clinical manifestion and operation of lumbar dise herniation

目的分析手术治疗745例腰椎间盘突出症的主要临床症状、体征与手术所见两者之间的关系有何异同.方法采用1982年至2003年经作者主刀手术治疗病例的临床症状、体征与术后所见进行统计分析,探讨其临床表现与手术结果的关系.结果腰椎间盘突出症的最主要症状、体征,包括96.4%有腰腿痛,93%腹压增高时症状加重,91.6%直腿抬高试验阳性,70.8%棘突旁有固定压痛和放射痛.手术所见,有77.6%突出物位于神经根前外侧,位于前内侧的只有10.9%,破裂或游离型11.5%.在突出物位于L4-5的病例中,有65.6%伸拇肌力减弱,位于L5～S1也有32.3%出现伸拇肌力减弱.结论虽然CT和核磁共振的广泛应用,为腰椎间盘突出症提供了快捷准确的诊断依据,但临床诊断的方法仍然是专科医生们最重要的常规方法.本文提示在诊断、治疗腰椎间盘突出症时,在注意该病共性的同时,不可忽视少数不典型病例的个性表现,力争做到诊断、治疗准确无误.

Objective To analyze the experience of 745 cases of lumbar disc herniation（LDH） and investigate the relevance between the clinical symptoms, signs and operative observation. Methods From 1982 to 2003, 745 cases of LDH were treated operatively. In order to investigate the relationship between clinical presentations and operative results, a statistic analysis was conducted using the clinical symptoms, signs and operative observations. Resalts As the predominant manifestions,the pain in the low back and leg was seen in 96.4% of LDH,the pain aggravated by belly pressure in 93 % of LDH, local tenderness and radicular pain around the lumbar spinous process in 70.8 % of LDH,rectoleg elevation test（ ＋ ） in 91.6 % of LDH. operation observation：77.6 % of LDH was classified as lateral type,10.9% as medial type and 11.5% as rupture or sequestration type. Weakness of extensor hallucis longus could seen in 65.6 % of LDH of L4, L6,in 32.3 % of LDH of L5S1. Conclusions Although the extensive usage of computed tomography（CT） and magnetic resonance imaging（MRl ） provides a prompt and accurate basis for diagnosis of LDH, the physical examination remains the most important routine way to make a diagnosis. It is suggested that during the diagnosis and treatment of LDH, besides the common features of the disease, some individual presentations should not be neglected in few rare atypical cases ,so as to diagnose and treat correctly.