椎间盘源性马尾综合征原因分析及处理

Analysis and management of cauda equina syndrome caused by protrusion of intervertebral disc

目的探讨椎间盘源性马尾综合征的发病原因﹑治疗方法和时机,重点讨论其发病机制及预防措施。方法回顾性分析13年间所遇18例出现急性马尾综合征的腰椎间盘突出症患者病历资料。其中16例均因椎间盘突出而行推拿、按摩及三维大重量牵引手法复位等治疗后出现马尾神经急性受损表现,7例出现足或足趾背伸肌力减退。18例均行手术摘除脱出的髓核。结果自主排尿功能16例于术后10d内完全恢复,1例于术后49d部分恢复,1例随访24周未见恢复。鞍区感觉障碍除1例外全部恢复。7例肌力减退者肌力3例完全恢复,3例部分恢复,1例无恢复。结论经影像学证实的临床表现典型的腰椎间盘脱出症,特别是脱出髓核已游离入椎管内者,推拿、按摩以及较为粗暴的大重量牵引手法复位治疗,如应用不当可引起严重的后果。建议首选手术治疗,

Objective To discuss pathogenesis, therapy and operating time of cauda equina syndrome caused by protrusion of intervertebral disc, and its mechanism and preventive method mainly. Method Retrospective study were made on the date of 18 patients who developed protrusion of lumbar intervertebral disc accompanied by acute cauda equina syndrome. Among the 18 cases 16 presented acute eauda equina injuries after treatment of prolapse of intervertebral disc by manipulation and traction, ankle weakness presented in 7 cases. All the 18 patients received operation for removing the hemia. Result On recovery from urinary retention： there were 16 cases recovered within 10 days, 1 case improved within 49 days after operation and 1 patient failed from recovery followed-up of 24 weeks; saddle anaesthesia： all patients recovered except for 1 patient; motor weakness： 3 eases recovered and 3 cases improved and 1 case had no improvement. Conclusion Typical manifestation of lumbar disc hernia recognized through photography should be received an operation first especially that the hernia had dropped into canal. Manipulation and traction should he forbidden because they can make a severe results from improper application.