胸腰段椎间盘突出症临床特点研究

Clinical characteristics of thoracolumbar intervertebral disc protrusion

目的研究各节段胸腰段椎间盘突出症临床表现的特点。方法回顾性分析我院自2000年4月-2011年1月手术治疗单节段胸腰段(T10-L3)椎间盘突出59例,其中T10-T11组5例,T11-T12组19例,T12-L1组12例,L1-L2组13例,L2-L3组10例。结果各个节段中常见的临床症状依次为根性放射痛(44/59,74.6%),行走障碍(40/59,67.8%),下肢麻木(37/59,62.7%)下肢无力(35/59,59.3%)腰背痛(29/59,49.2%);T10-T11组和T11-T12组以下肢麻木无力表现为主,主要表现上运动神经元损伤的体征;T12-L1组多伴有腹股沟区域感觉平面(6/12,50.0%)和鞍区感觉障碍(4/12,33.3%),以下运动神经元损害和混合型损害体征为主;L1-L2组和L2-L3组表现为神经根症状,累及范围主要在大腿前外侧,主要表现为下运动神经元损伤体征。不同节段腰背痛发生率比较有统计学差异(P<0.05),下位节段腰背痛发生率高于上位节段。结论 T10-T11组和T11-T12组表现为上神经元受损,T12-L1组表现为明显感觉平面和广泛下肢力弱,L1-L2组和L2-L3组表现根性感觉和运动障碍。

Objective To study the clinical characteristics of thoracolumbar intervertebral disc protrusion.Methods Clinical characteristics of 59 patients with thoracolumbar intervertebral disc protrusion（T10-L3） undergone operation in our hospital from April 2000 to January 2011 were retrospectively analyzed.The patients were divided into T10-T11 group（n=5）,T11-T12 group（n=19）,T12-L1 group（n=12）,L1-L2 group（n=13） and L2-L3 group（n=10）.Results Radiating pain,ambulation disability,numbness and weakness of lower extremity,and back pain occurred in 44,40,37,35 and 29 of the 59 patients respectively,with an incidence of 74.6%,67.8%,62.7%,59.3% and 49.2%,respectively.The main symptoms of T10-T11 and T11-T12 groups were numbness and weakness of lower extremity manifested as injury of upper motor neurons.Sensory disturbance was found in groin and saddle regions of T12-L1 group,manifested as lower motor neuron injury and mixed injury,with an incidence of 50.0% and 33.3%,respectively.The radiculopathy and sensory distrubance mainly involving the anterolateral leg in L1-L2 and L2-L3 groups were manifested as injury of lower motor neurons.The incidence of back pain was significantly different in different groups（P0.05）,and much higher in the lower groups than that in the upper ones.Conclusion Upper neuron injury occurs in T10-T11 and T11-T12 groups,sensory disturbance and weakness of lower extremity occur in T12-L1 group,sensory disturbance and dyscinesia of nerve roots occur in L1-L2 and L2-L3 groups.