腰椎间盘突出术后复发性坐骨神经痛的临床特点及鉴别

Clinical Characteristics and Distinguish of Recurrent Sciatica after Lumbar Discectomy

本组共148例,其中120例拟诊为原发性腰椎间盘突出症而行常规髓核摘除术。余28例为复发性坐骨神经痛,拟诊复发性椎间盘突出,再次外科手术治疗,其中10例术后诊断为硬膜外及脊神经根纤维粘连。依据术后诊断,将全部病例分为三组。分析统计各组疼痛性质、止痛剂应用情况、首次手术后疼痛缓解时间等病史特点:直腿抬高试验、腱反射、拇背伸力等临床体征及CT、MRI等影像学表现。认为咳嗽时疼痛加重、最大行走距离明显减少、直腿抬高〈30°等三项参数,有助于鉴别复发性椎间盘突出与纤维粘连性坐骨神经痛。

A retrospective study with preoperative collection of data was undergone in 148 cases with primary lumbar disc herniation and recurrent sciatica. According to postoprerative diagnosis, they were divided three groups: primary herniation, recurrent herniation and fibrosis. After analyzing the frequency of common symptoms and signs, the author think that the best symptoms and signs to distinguish between recurrent herniation and fibrosis were pain upon coughing, a severely reduced walking capcaity, and straight leg raising test positive less than 30°.