误诊为腰椎间盘突出症的病例分析(附34例报告)

An Analysis of Misdiagnosis of Lumbar Disc Protrusion(A Report of 34 cases)

目的 :分析误诊为腰椎间盘突出症的病例 ,探讨其原因。方法 :收集误诊误治的腰椎间盘突出症 3 4例 ,其中 2 7例 ( 79 4% )进行过影像学检查有所改变 ,其中CT为 19例 ,MRI 5例 ,脊髓造影 3例。改正的诊断为 :腰臀部软组织疾患 15例 ,其中盆腔出口综合征 10例 ,臀肌劳损 2例 ,棘间韧带损伤 2例 ,L3横突综合征 1例 ;肿瘤及瘤样病变 7例 ,其中脊髓肿瘤 3例 ,椎体肿瘤 2例 ,神经纤维瘤及蛛网膜囊肿各 1例 ;腰椎骨关节病变 4例 ;脊髓型颈椎症 2例 ;肢体远端软组织病变 4例 ,非骨科疾病 2例。 3 4例中 5例已在他处作了腰椎间盘切除术 ,3例已决定作腰椎间盘切除术 ,2例已作了胶原酶注射治疗。结果 :2例转科治疗 ,3例拟定手术经作者改正诊断后取消 ,7例肿瘤切除术 ,2例颈椎后路椎管减压术 ,3例软组织松解术 ,1例结核病灶清除术 ,其余均经局封治愈。术后随访 6～ 90个月 ,平均 16 4月 ,疗效满意。结论 :对腰腿痛病人应重视病史及临床检查 ,认真分析影像学表现的参考价值 ,防止误诊为腰椎间盘突出症而误治。

Objective:To study the causes of misdiagnosis and faulty treatment of lumbar disc protrusion.Methods:34 cases of mis diagnsis and faulty treatment of lumber dise prolrusion had been analvzed.Among them 27 cases,in 79 4% of 34 cases,19 had CT,5 had MRI and 3 had myelography been examined and some positive discovery had been found.According corrective diagnosis,there were 15 cases with soft tissue lesion of buttock,among them,10 sciatic nerve pclvis outlet stenosc syndrome,2 were straining of gluteus,2 were strainig of interspinal ligament,and one was transversal process syndrome of L 3;there were 7 cases with tumors or tumor like lesions;they were 3 in spinal cord,2 in vertebrae,1 neurofibroma and 1 arachnoid cyst;there were 4 cases with disorders of bone and facet joints;there were 4 cases with soft tissue lesion of lower extremities;there were 2 cases with cervical myelopathy,and there were 2 cases with nonorthopaedic diseases.Five cases had been operated on lumbar discs.Three cases had been decided to operate but the operation was then canceled.And 2 cases had been treated by injection of collagenase.Results:After rectified diagnosis,2 cases were transferred to other departments,7 cases had tumor excised,2 cases had cervical laminoplasty performed,3 cases had nerve related,one cases had T.b focus debrided and the rest cases had locally bocked.Follow up period from 6 90 months with an average of 16 4 months,results are satisfactory.Conclusion:It is very important that detail history of illness and clinical examination to be performed for patients with lower back or leg pain,and objectively analysis discovered images to prevent misdiagnosis and wrong treatment.