极外侧型腰椎间盘突出症临床特点及分型意义

Clinical features and classifying significance in far lateral lumbar disc herniations

目的探讨极外侧型腰椎间盘突出症(FL-LDH)的临床特点与分型意义。方法回顾性分析22例FL-LDH病例,根据陈仲强分型进行分类,并比较不同类型FL-LDH临床症状体征、治疗适应症及疗效。结果①FL-LDH分类Ⅰa型9例、Ⅰb型3例、Ⅱa型6例、Ⅱb型4例。Ⅰ型病例腰腿疼痛剧烈,尤以下肢根性损害重,多表现为股神经损害;Ⅱ型病例临床症状相对较轻,特别是Ⅱa型多无明显腰腿疼痛。②经6个月以上随访,治疗后FL-LDH各组临床症状均明显缓解,JOA分值显著增加、VAS分值明显减少(P<0.05);随访结果优14例、良5例、可1例、差2例,治疗优良率达86.4%。结论①FL-LDH分型具有临床实用意义,临床症状与突出椎间盘相对位置有关,向上移位者症状重。②在恰当掌握治疗适应症前提下,FL-LDH具有满意的临床疗效。FL-LDHⅠ型应以手术治疗为主,Ⅱ型可行非手术治疗。

Objective To explore the clinical features and curative effects of far lateral lumbar disc herniation （ FL- LDH）. Methods According to Chen＇ s classification, 22 FL-LDH cases were studied retrospectively. Different types of FL- LDH were compared to analyze the clinical features, treatment indications and outcomes. Results ① There were 9 cases in Type Ⅰ a, 3 cases in Type Ⅰ b, 6 cases in Type Ⅱ a and 4 cases in Type Ⅱ b, altogether. Cases in Type Ⅰ usually had serious lumbago and lower limb pain. Nerve root lesions, in which femoral nerve was frequently involved, presented severe symptoms. While cases in Type Ⅱ had relatively slighter symptoms, even with no obvious representations. ② After at least 6 months fol- low-up, all the groups improved with JOA and VAS scores changed significantly （ P 〈 0.05）. The outcome showed excellent results in 14 cases, good in 5 cases, fair in 1 case, and poor in 2 cases. As a whole, the improvement ratio was 86.4%. Condnsion ① The classification in FL-LDH is a practical system indicating the relation between the clinical symptoms and herniated discs＇ positions. The cases having the superior shift of the protruded discs incline to represent more severe symptoms. ② On condition of the proper treatment schemes, FL-LDH will undoubtedly have a satisfied outcome. Surgery should be considered in Type I cases, while conservative treatments apply to Type Ⅱ cases.