极外侧型腰椎间盘突出症的临床特征及手术治疗

The feature and surgical treatment of extreme lateral lumbar dosc herniation

目的探讨极外侧型腰椎间盘突出症的临床特征及手术方法。方法对我院近年收治的11例极外侧型腰椎间盘突出症患者的临床资料进行分析。结果本组11例,男7例,女4例。年龄27～65岁,病程2个月～5.5年。突出间隙在腰4、57例,腰3、43例,腰5骶11例。突出部位在椎间孔内8例,椎间孔外3例,其中合并后外侧突出3例。以下肢疼痛剧烈而腰痛轻微,大腿前方与小腿前内侧疼痛或麻木,股神经牵拉试验阳性,膝反射减弱或消失等为突出的临床表现。11例均手术治疗,5例经椎间板入路,4例经椎板峡部外缘入路,2例经横突间入路,均取得了良好的疗效。结论与典型的腰椎间盘突出症不同,极外侧型突出多累及同序数腰神经根。CT或MRI可清楚地显示位于椎间孔或孔外缘突出的椎间盘组织,此对于诊断及指导手术有重要价值。极外侧型腰椎间盘突出症一经确诊,应尽早手术治疗。

Objective To investigate the feature and surgical results of extreme lateral lumbar disc herhiation（ELLDH）. Methods There were 11 cases of ELLDH, male 7, female 4, the average age were 45.7. 7 cases appeared in L4.5 ,3 cases in L3. 4 and one case in L5S1. The clinical symptoms, physical signs and imageologic character of l l cases ELLDH were analyzed.Results Contrasted to typical disc herniation, ELLDH in volved the upper nerve root mainly. The dominent symptoms and signs were severe anterior thigh and lower leg pain, positive femoral nerve strech rest, impairment of knee jerk reflex. Conelusion CT/MRI showed the protruded disc in and outside of the foramen clearly. It was thought to be ideal method for the precise diagnosis and guidance of surgery. Surgical treatment should be chosen as soon as possible once diagnosis is macle.