临床症状与髓核突出左右不一致的腰椎间盘突出症的诊治

Diagnosis and treatment of unilateral lumbar disc herniation with contralateral symptom

目的探讨腰椎间盘突出症导致非对称性下肢放射痛的可能原因及术式的选择。方法25例经SCT、MRI检查证实为突出侧与临床症状侧别左右不一致的腰椎间盘突出症患者，均行手术治疗，其中14例行双侧开窗减压探查髓核摘除术，11例仅行突出侧开窗术。结果影像学上髓核突出侧别与术中所见相吻合，但该侧神经根未见到明显压迫或炎性水肿等病理表现；而症状侧无髓核突出，5例神经根未发现异常表现，9例存在不同程度的炎性水肿，其中6例探查发现神经根与对侧髓核不同程度粘连。术后所有患者症状均得到缓解，经过1～5年（平均2．4年）的随访，均无复发。结论SCT结合MRI检查有助于此类腰椎间盘突出症的明确诊断。纤维环无破裂的突出型腰椎间盘突出症，单纯突出侧减压可以获得较好的治疗效果；纤维环破裂的游离型及脱出型腰椎间盘突出症，宜同时行对侧开窗探查。

Objective To explore the cause and the surgical methods for the particular type of unilateral lumbar disc herniation with symptoms on the contralateral side. Methods 25 patients who had suffered from this kind of disease and confirmed by MRI and SCT were operated. Bilateral exploring for 14 cases or unilateral exploring for 11, the herniated discs were removed. Results The position of nucleus pulposus in operation were identical with the radiograph- ic results, but compression or inflammatory edema of nerve root was not found. There was no disc herniation in the symptomatic side, and pathological changes of nerve root wasn＇t observed in 5 cases, but were found in 9 cases, of which the nerve root adhesion to contralateral side nucleus pulposus for 6 cases. The symptoms of all cases were released postoperatively. All were followed up for 1 - 5 years with an average of 2.4 years without recurrence. Conclusions SCT and MRI are helpful for the diagnosis of the particular type of lumbar disc herniation. Lumbar disc herniation without annulus fiber tears can obtain perfect effect with simple decompression operation of nucleus pulposus side; Lumbar disc herniation with annulus fiber tears should be performed bilateral decompression operation.